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Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant:
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Customer Code: Customer Name: Customer Job Number: Order Code/Date:
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Project Code: Project Name: Project P.O.Number: Order P.O.Number:
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Ticket Date: Delivery Address: Map Page: Map/Row/Column:
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Delivery Instructions: Dispatcher:
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Ticket Number:
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Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use:
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LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION u6m UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY
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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:
r WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
1�:ONC:RE 16= DI S"t='13F,"1_ F=LE'.
SIGNATURE
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--— D 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
terns of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to your s fety 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, d to,the material safety data shefts fdr 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. �i IP
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68UNIVERSAL 1-RE J 'TR-,.- INVOICE / Ci ;
'['his Delivery Picket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotation, if any, and Seller's Order Confirmation (including limitations of warranties), as if fully
set forth on this Delivery".Picket(`Agreernent"). Seller will provide the Standard Terms and Conditions upon request. Buyer agrees
that, unless otherwise rioted on the front hereof, all quantities and items were delivered as indicated arid further expressly agrees to
pay in accordance with t:lle Agreement. "
AGGREGATE / CEMENT / CO.NCRETE PRODUCTS / FLY ASH
Aggregate products are naturally occurring materials including limestone,dolomite,granite,volcanic rock,sand,gravel,and other
siliceous materials. Cement 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 11), ash, may-contain mbre't:han 0.025%, crystalline silica.
Hazards: Freshly mixed wet.cement and/or fly ash can cause eye irritation, skin and eye burns and allergic skin reactions.
Dry concrete and i!ggregate dust may cause irritation to eyes, skin, and/or respiratory tract.Dust Bonn handling,
crushing, grinding, cutting and/or drilling may contain silica, which may cause silicosis and cancer, if inhaled.
I:f ingested, keep warm, at rest, and drink large amounts of water. Fly Asli may contain trace amounts of ammo-
nia. :Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation
or bt'rrls 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 thorouglll.y with mild soap and water.after handling. Avoid breathing dust. If exposed to
(]List above recommended limits (see MS:DS), wear suitable NIOSH-approved.respiratory protection.
First Aid: In case of eye contact, immediately flush eyes with flowing water for 15 minutes.If dust is inhaled,move to fresh
air. If wel cement contacts skin, rinse thoroughly with water. Get proper medical attentionif irritation persists.
CEMEX. Memorial 1-lemiann Tower
929 Gessner. Suite 1900
V7 combined 1-louston. Texas 77024
02/12 For more information please visit www.cenlexusa.com.
.Este ticket de entre`-a illclu_ye como referencia a1 comprador (ya previarnente ejecutada ell su aplicacn.6a Cle cr6dlto); cualquier
t6rnlino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y
oarantfas),como acuer(lo total dei ticket de entrega("Contrato''). El vendedor proveera los termirios estandares y condiciones detal-
lados en caso de asf,cr requcridos.Con este dOCUmento,el comprador acepta los misrnos ya antes mencionados y que las cantidades
y materiales fueron entregados como se expresa en el rnismo.Acepta pagar el monto do acuerdo at contrato: at menos que se identi-
fique con urla notal ,it frente de este documento.
AGIREOADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales ilat.ur ales coino piedra caliza, dolomita, granito, coca volOnica, arena, Brava y otros
materiales silicios. Los productos de cernento incluyen Cemento de Lipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concretO incluyen cernento Portland y productos de agregados como piedra caliza, dolomita,
granito, rota volcanica, arena. Brava, y ot.ros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) ]a cual puede
contener m is de 0.0251% de si Iicio cristahilo.
Peligros: Mezcla de cernento fresco y/O cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en Piet y Ojos, y
reacciones alergicas en la piel. Concreto seco y polvo de agregados,pueden causar irritacion en los Ojos,piel y/o en
]a zona respiratoria. Polvo del manejo en el trituramiento. pulido, Corte y/o perforaci6n puede contener materiales
silicos,los cuales pueden causar silicosis pulmonar y cancer si.son inhalados. En caso de ser ingeridos,mantenerse
en temperatura e lido,reposar y tomar grander cantidades de aqua.Las cenizas volantes pueden contener amoniaco.
Segut•idad: La humcdad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toner, irritacion o
quemaduras en la nariz, garganta y pulmones.Acudir inmediatanlente al medico. .El riesgo en la salad.depende en
la durac.i6n y el nivel de la exposici6n.
Seguridad: E'vite el contacto con ojos y contacto prolongado con ]a piel. Use guantes,protecti6n en los ojos y ropa
Primeros adecuada para proteccion..Lavese.]as manor con jabon suave y aqua despues del.manejo de materiales.Evite inhalar
auxilios• polvos. Si se expone a polvos nlas_de los lignites recomendados,use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los Ojos, inrnediatarnente fluya agua en.la parte afectada por 1.5 minutos.
Si se inha.la polvo, exp6rlgase a wire fresco. Si el cemento fresco tiene contacto con sus Ojos, lavelos a fondo con
aqua.Acuda it £1fer1G6n g'r1Cd1CS1 I1'lllledlatia111ellte Sl la lrl'll'a( 6r1 CO11i1rlUa.
CE'MEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston,Texas 77024
02/12 Para mas iriformaciorg visita www.cemexusa.com.