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Customer Code:. ! Customer Name: Customer Job Number: Order Code/Date:
D( ( Y 4dILLIAMS 1l� 1 / -/15
roje et ro�Jeo Name j Project P O Number Orer�P O Numb`— r" c
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Ticket Date Delivery Address fviep"fjagPL nnaDpiAow7bolumn ,
DCS.EAMS,.
i Ticket Number:
YYY 444 _
34117137
Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use:
1 .40 5. 0liiC 5754 109 :14 TYRONE WILFORD RDWAY: DRIVEWAY
LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION _7U_
0M UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY
10. 50 REG/FIBERMONO—FIR
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i, oc1 1 !€ $16 FUEL SURCIAFXE
OP 1202749 ENV.:IR01�lMEN1 L C-id 4
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Cash Check#/Aulh Code: Signature of Driver'Receiving Cash: Cash Received: Total COD Wder Amount to Collect
Check i Without Standby Charges:
Charge
Comments:
WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
'OIC RETE DISPOSAL FEE
PARTIAL_ FULL LOAD _YARDS SIGNATURE
❑ LOAD WAS TESTED BY: :.
Notice: Our drivers will make every effort to place materials where the customer designates,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 longer 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 safety handling information,and to the material safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATURE:
within one business day after the receipt of materials. O �'
PREV TRK: LOAD NUM: 1
68UNIVERSAL ORIGINAL