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CERTIFICATE;.OF TERM TREATMONT
CC M.'' M -l'.SC►I1.°7`REATMENT
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MA. ;.1 �3 AODRM:=o PjecaalA Ptort pis ,::F
+ OMDER/CONTR�
P CONMtX:
CO :. rnusty`e Piet corstrot PET'"CmIT3C
CE #-.' f X3203 _
Wei.:the:,undersigned,hereby:c�artllyr i�ot wo have pretreat a above�descritied,con* for
subterranean:termites`!n ac ocdance;Wb ttie standards of the Na#onal";Pest ontrot lA socia#on
Square t ff area=treated-., .7e Cherrilrals used.-U Oaf
Psr mage orf Saltation: o oe s; -_
TbW gallons`used:,Tu.
Llate of fireatmsnh_zorrtse. __ Trre;of'*r.reatxrisrit;°
—1�k T'reatmer#t _ 1't TreatmeriE
_ -fte=Tread . . Re-Treat
1' `Treat ►ent fA Treatment
R_e-Treat
. _ Perlmater fcu Final in . n.
int Treatment?
R&Treat 4.
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Sigr�ttare` , rminatar
1Yct+� must fie a comdm eadi nAqulrl tatrr�nt of: irb7J grad tis lbrm mart be on aie,�vb:
site ab b�XVic�dryc?by�6hie Tiup�rhar.at dire ofe,�afr 1e�r�►ertlo�t��Yx�J�dlrrsp�et�;n wi!!,fk,U'ano►ar r�=rit"�ri
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sha�ilkr tti d�pikate rrtmentCr 'lfiates as eurc�'t. tredov—
ae tatmrtJsrrrr ,
or ,a roPY 1br t heQen to:tlre,o i»It tn.anod ario3ber c+gay ft dre NAMr4r,a ,►mlt A& :b Tr txtt ttt
Cori to s 1l,aavldde the pnadrrct u It entity of a a/ JlrAtr�r; dote 011. Li�it4'o tfi tr adrW site lacaGbvr,ansa
treated,a'e :tamer p nt, b'la>and numb+erof albns ab.:estwma ve1JtaWe ie rd o1
Prt? beatraenG �7`Nrr sit itifllri* r:tEur to Is 'ean►aw.tiea$i> !!sa!,ist1`
ae cv+n�tLd r tn�+9rtal'bt�flr�i��arois�►
S't nuc�a Ci n requtt"&-t ow n"I liwpeCOM fa'C0►,a Penreenerrt 3tkker bo_be'p!aci d t
the ed trlcai panel bmt+caner,listln0"MM M:tf=tMQnW and'dam of bppXkWons.
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cmcx 58- ' 67801 -
Plan
8 ' 67801 .Plant: Begin Loading: To Job: Arrive Job: Start Unload: . Finish Unload: Leave Job: Return Plant:
Customer Code: Customer Name; Customer Job Number: Order Code!Date:
f
Project Gode ;Projec Name •••� {f } rr^•y y r t, # r f ••y{}b Project P.O.Number: '" Order P.O.Number 1,,,•
... ,..t_..F...1 Sn. (# Ir.l,�k_..a.L... 1 L.�ro. P��E iT,i• f..-. d r':d.�!t4�1 - �t ,4;.3- j...5
Ticket Date: Delivery Address: lylap•�age; t Map/Row/Column:
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DeliveryInsWctions j. .,' 17"
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e. .+. .� ?r•i`t �. ,t1. r 111 t >"j• t/ tf Dispatcher.
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/ Ticket;mber'IE' _
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Due On Job: Slump: Truck Number: Driver Number: TDr,,iver Name: 7se:
� ta
"i (-k`•t - 'r i`}=d? • •s}-'�r'I_..., i ri 1Y._3, T tai i,.
.LOAD. . CUMULATIVE; .ORDERED �y MATERIAId CODE r :PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY' 1 >QUANTITY<•''1
!.. u ci,' ;� ��1 __��.a 4?-} � r°{'��, � .:r�_jr_�t..+ jj.�C-f� r+.... 1 � ��- .I"%t�} t�!•-' 3• 7 .. .It•1 ,
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_ 7�4 -�..lt•. } } rt�t ? A\`t}t{ aii 2 !! 7' s� ir°'(. s�.:,;lt_. a 4 ? �"t°.i',':I.1�:l..,il3�iY1¢:.;,€TFtk.. t i'iAF�G#:.
Cash Check#/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
Check
Comments''> i f i'l;)i''.r;';•1• 7.F i,i F C;°i jla`{i""i4 'Ir ld f {"fr }:'r
C
��r r
WATER ADDED:�—� "� GAL YARDS IN DRUM:
r/ WHEN ADDED.
SIGNATURE
CURB LINE OSSED AT 0 .(BIER'S/AGENT'S REQUEST:
SIGNATURE
E�=C' 1:1 PL. c=l.11_.t... t._t_��1 ::t _._ _.__.. 'lfwllyjY+��
- ,, C3LOAD AS TESTED BY:
Notice: Our drivers will make every effort to place materials where the customer desld ate ,but the SPECIAL TERMS: Any water added is at customers own risk. If water is added on job,concrete strength
Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is no IQnger guaranteed. WARNING: Product may cause skin and/or eye irritation. CAUTION: Material
terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to your safety and health. Please refer to the backside of this ticket for important
control after delivery,this Company will not accept any responsibility for the finished results. No credit for safet"handling information,and to the material safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless ma��totus in writing AUT PORIZED'SIGNATURE:
within one business day after the receipt of materials. / �/ / /� !( i e
68UNIV.ER9AL•' V%."ii'+1''rrIf"t:li mi f�. / LOIPID r\,U11 fin I
{ I!"L t,,.•.la i. CUSTOMER
This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions,Seller's Quotati f any,and Seller's Order Confirmation (i Eding limitations o�r-\Tarnt Mies),as if fully
set forth on this Delivery Ticket("Agrc�,._at"). Seller will provide the Standard Wer,__ --nd Conditions upon request.Buyer agrees
that,unless otherwise noted on the front hereof,all quantities and items were delivered as indicated and further expressly agrees to
pay in accordance with the Agreement.
AGGREGATE / CEMENT / CONCRETE PRODUCTS /I'LL' ASH
Aggregate products are naturally occurring materials including limestone.dolomite,granite,volcanic rock,sand,gravel,and other
siliceous materials. Cernent products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete
products include Portland cement and aggregate products including limestone,dolomite,granite,volcanic rock,sand,gravel,and
other siliceous materials.These products, including fly ash,may contain more than 0.025% crystalline silica.
CAUTION!
Hazards: Freshly mixed wet cement and/or fly ash can cause eye irrigation,skin and eye burns and allergic skin reactions.
Dry concrete and aggregate dust may cause irritation to eyes,skin,and/or respiratory tract. Dust from handling,
crushing, grinding,cutting and/or drilling may contain silica, which may cause silicosis and cancer if inhaled.
If ingested,keep warm,at rest,and drink large amounts of water.Fly Ash may contain trace amounts of ammo-
nia. Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation
or burns of the nose,throat and lungs. See physician. Health risk depends on duration and level of exposure.
Safety: Avoid contact with eyes and prolonged contact with skin.Wear gloves,eye protection,and appropriate protective
clothing. Wash hands thoroughly with mild scrap and water after handling. Avoid breathing dust. If exposed to
dust above recommended limits (see MSDS),wear suitable MOS.II-approved respiratory protection.
First Aid: In case of eye contact,immediately flush eyes with flowing water for 15 minutes.If dc[st is inhaled,move to fresh
air.If wet cement contacts skin,rinse thoroughly with water.Get proper medical attention if irritation persists.
CE.MEX,Memorial Hermann Tower
929 Gessner,Suite 1900
V7 combined Houston,Texas 77024
02/12 For more information please visit www.cemexusa.com.
Este ticket de entrega incl.uye tomo referencia al comprador (ya previamente ejecutada on su aplicac16n de credito)-, cualquier
termino estdndar, conditions del vendedor, propuestas del vendedor y Orden de confirmaci6n del vendedor (con limitaciones y
garantfas),Como acuerdo total del ticket de entrega("COntrato").EI vendedor proveerd los terminos estdndares y condiciones detal-
lados en caro de asf ser.requeridos.Con este documento,el comprador acepta los mismos ya antes mencionados y que las cantidades
y materiales fueron entregados como se expresa cn el mismo.Acepta pagan el monto de acuerdo al contrato; al menos que se identi-
fique con Una nota al frente do este documento.
AGREGADOS / CEVMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, coca volcanica, arena, grava y otros
materiales silicios. Los productos de cemento incluyen Cemento de Lipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito,.rota volcdnica,arena,grava,y otros materiales silicios.Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mds de 0.025% de silicio cristalino. `
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritation en los ojos,quemaduras en piel y Ojos,y
reacciones alergicas on la piel.Concreto sero y polvo de agregados,pueden causar irritaci6n en los ojos,piel y/o en
la zona respiratoria. Polvo del manejo en el.trituramiento,pulido,conte y/o perforaci6n puede contener materiales
silicon,.los tuales pueden causar silicosis pulmonar y cancer si son inhalados.En vaso de ser ingeridos,mantenerse
en temperatura calida,reposer y tomar grander cantidades de aqua.Las cenizas volantes pueden contener amoniaco.
Seguridad• La humedad puede causar la liberation del amoniaco. La inhalation del amoniaco puede causar toser,irritaci6n o
quemadu.ras on la nariz,garganta y pulmones.ACUdir inmediatamente al medico. El riesgo en la salud depende en
la duration y el nivel de la exposition.
Seguridad: Evite el contacto con ojos y contacto prolongado coni la pie]. Use guantes,protecci6n on los ojos y ropa
Primeros adecuada para protecci6n.Ldvese las manos con jab611 suave y agua despues del manejo de materiales.Evite inhalar
auxilios: polvos. Si se expone a polvos mds de los limiter recomendados,use protecc16n respiratoria.
Primeros auxilios: En caro de contacto en los Ojos,inmediatamente 17uya agua en la parte afectada por 1.5 minutos.
Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco bene contacto con sus ojos, lavelos a Tondo con
agua.Acuda a atenc16n medica inmediatamente si la irritaci61l continua.
CEMEX.Memorial Hermann Tower
929 Gessner,Suite 1900.
V7 combinado Houston,Texas 77024
02/12 Para mds information visita www.cEi_r.exxLisa.com.