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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:
Project Code: Project Name: Project P.O.Number: Order P.O.Number:
Ticket Date: Delivery Address: Map Page: MapiRow/Column:
Delivery Instructions: Dispatcher:
Ticket Number:
I
Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use:
LOAD CUMULATIVE ORDERED
QUANTITY QUANTITY QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
Cash Check#/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Check without Standby Charges^-,__
Charge
Comments:
WATER ADDED: GAL YARDS IN DRUM:
d r` WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
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 stref
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: M5,6t
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 imr
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.
sti ERSAL INVOICE /
This Delivery Ticket incorporates herein by reference-Buyer's previously exeCUICd Credit. Application, if any, Seller's Standar.
Terllis and Conditions, Sellers Quotat* - if any, and Seller's Orcicr i'onfirmation (+^ ludin, li m ilatiur,.;of'wait;ultics), as if fully
set forth on this Delivery Ticket ("Agrlent"). Seller will providf the Stand; ?.l Tel
Conditions uprn, rcytost. Buyer agrees
that. unless otherwise noted on the I'ront hereon, all quantities and items w re d:lig Bred a, indicated and f urther,_\pressly agrees to
pay in accordance with the Asireement.
AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH
j Aggregate products arenaLuralfy (�ccin rine materials includin`t limestone,,dolomite,cranitc,volcanic rock, sand.gravel,and other
Siliceous materials. Cement products include Portland cement, masonry. poz_zolan (Type fl?). rool' tile. ind stucco. Concrete
pr�)CILMs include Portland cement and agyregate products irlcludiu;'linlestonc, CIOlonlite, grauitc. volcanic rock. sand, gravel, and
Other siliceous materials. "I hese prOdUCLS, II1ChIdlig Ily ash. may contain more than 0.02 % cn,�taiiinc 5ilicsl.
! Hazards: Freshly mixed wet cement and/Or fly,a ldl can cause eye.irritatiun. skin and et,e burns and aller,Lic skin reactions.
' Dry concrete and aggregate dust play cause irritation to eyes, skin, and/or respiralory tract. Dust from handling,
crushing. grinding, cuttin- auld/or drillin- may contain silica. which play cause silicotii. old cancer it inhaled.
+ If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo-
i nia. MOiSturL can cause the ammonia to be released. Inhalation of ar11i1 omit.can CaIISc cou°hill`,? and irritation
or burns of the nose, throat and lungs. See physician. Health risk depends on (ILl:•,tion and level of Q'xposure.
Safety': Avoid contact with eyes and prolonged contact with skin. Near gloves,eye protection, and appropriate protective
clothing. Wash hands thorolighly with mill soap and water after handhno. Avoid brcathing dust, if exposed to
dust above recommended limits (see MSDS). wear suitable NIOSH-approved respiratory protection.
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First Aid: In case of eyc, contact, Inimedialcly flush eyes with flowing water for 15 minutes. 11'dust is inhalcd, move to fresh
air. 11'wet cement contacts skin, rinse thoroughly with water. Get proper medical attention it*irritation persists.
Ct MEX. Memorial Hermann Power
929 Gessner, Suite 1900
V7 combined llouston, Texas 77024
02/12 ' _- For more information please visit.www.cenit;xus1l.c0ll1.— ------
Este ticket de entrega irlcluye Conlo referencia al con,prador (ya previamente ejecutada en su aplicaci6n de Credito); cualquier
t&mino estandar, condiciones del vencledor, propuesm, del vendedor y Orden de confirmaci6n
starantias).Como acucrdo total del ticket (le entreg,(`Car ntto=)- 1 vcndedo�provecrai los terminos cstzindares y condiciones detal-
;ados en catso de asf ser requerldos.Con este documento,cl coinprador acepta los mismos ya,files n,encionados y que_las canUdaCtes
y nlateriales fucron entregacfos conlo se expresa en el lni,mo.Acepta pagar Of monto de acucrdo al conuatu; ,l mcnos gtle se identi-
fidue'con unit nota al frente de cyte documento.
AGREGADOS / CE1MENTO / PRODUCTOS DE CONCRETO / CENIZAS,VOLANTES
LOC ,l'OCIUCIO, de agregados soli materlales n,turales Como piedra caliza, dololnita. oranito, i'oca volcdnica. arena. Brava v otros
materiales silicio�. Los productos de cemcnto incluyen Cemento de tipo Portland; de albarlilerfa, pOzzolan (tipo IP), azLllejo de
azotea y estuco. Los productgs de concreto incluyen cemcnto Portland y productos de agregados Como piedra caliza. dolomita,
�[d[llto. coca volctlnica, arena. arava. y otros matcriales ;ilicios. Estos productos incluyen cenizas volantes (fly ash) la coal puede
�� conte,ner roande 0.025% de silicio cristalino.
;CUIDADO!
Pdjgros: Mezcla do cemcnto fresco y/o cenizas volantes pueden causar in-itaci6n en los Ojos, qucnladuras en peel y Ojos, y
I rcacciones alcrgicas cn la piel. Concreto seco y pnivo do agregados, pueden causar irritaci6n cn los ojos, piel y/o en
la zona resptratori,. Polvo de] manejo en el trituramiento, pulido, corse y/o perforac16n puede convener nlateriales
silicon,los cuales pueden causar silicosis puhnonar y cancer si Son inhalaclos. En caro Cie ger ins>eridos, mantenerse
en temperatura calida.reposar y tomar grander:canti(fades de aqua. Las cenizas volanies pueden comcner anloniaco.
La humedad puede causar la liberaci6n del amomaco. La inhalaci6ll del amoniaco puede causar loser, irritacion o
Seguridad: (iLlellMdUras ell la nariz, g,arganta y pulmones. Acudir inmediatameme al medico. EI riesgo ell la salud depende en
la duraci6n y Of nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantc,, protec•c•idn en los ojos y ropy
1'rieneros admlada para protecci6n. Lavese las mcnos con jab6n suave j%aqua clespuzs clef manejo do materiales.Evite inhalar
1 al,xilios: polvos. Si se expone a polvos Inas de los llmites recoincrldados. use protecci6n respirworia.
Prlllleron auxlllon: Ell caro de contacto ell los ojos, 1?li.`_dlatarnente fitly,a'"Lla ell la parts' afeciada poi' 15 millutos.
Si se inhala polvo, exp61lgase a aire fresco. Si el cemcnto fresco bene contacto con sus ojos. laivelos at Tondo con
aqua.Acuda a atenci6n mcdica inmedia tamente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
- 929 Gessner, Suite 1900 I
V7 COmbinado Houston,Texas 77024 I
02112 Para mitis inforrrt.rci6n visita� -�mexttsa.com.