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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:
t .Project'Code: I ProjectjName:,i. ffi s t i Ft `lr S Project P.O.Number: }Order P.O.Number:j
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Ticket Date: Delivery Address: Map Page: Map/Row/Column:
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Delivery Ihstnictions: Dispatcher:
Ticket Number:
Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use:
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LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY c r
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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 - 8 7 r 6
Comments:
WATER ADDED: GAL YARDS IN DRUM:
\ 6�Q WHEN ADDED.
SIGNATURE
LC \A CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
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❑ 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 andlor 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 healthf 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 materral 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.
68UNIVERSAL P -C Et; CR
INVOICE
This Delivery Ticket incorporates herein by reference Buyer's previously execu" ' --redit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quo n, if any, and Seller's Order Confinnatioi eluding limitations of warranties),as if fully
set forth on this Delivery Ticket("AL nent"). Seller will provide the Standard Terms and Conditions upon request. RaryN•agrees
that, unless otherwise noted on the front hereof, all quantities and items were delivered as indicated and further expressly agues to
pay in accordance with the Agreement.
AGGREGATE / CEMENT / CONCRETE 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 fly ash, may contain more than 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 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. Irrlralation of ammonia can cause coughing and irritation
or burns of the nose, throat and lungs. See physician.Health risk depends on duration and let.cl 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 soap and water after handling. Avoid breathing dust. U.exposed to
dust above recommended limits (see MSDS),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 wet cerilent contacts skin,rinse thoroughly with water. Get proper medical attention if ifritation persists.
CEMEX, 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 incluye como referencia al comprador (ya previamente ejecutada en su aplicacion de creclito); cualquier
ter-mino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmation del vendedor (con limitaciones y
garantias),como acuerdo total del ticket de entrega("Contrato").El vendedor proveera los terminos estandares y condiciones detal-
lados en caso de asi ser requeridos.Con este documento,el comprador acepta los mismos ya antes mencionados y que las cantidades
y materiales fueron entregados como se expresa en el mismo.Acepta pagan el monto de acuerdo al contrato; al menos que se identi-
fique con una nota al frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales comopiedra caliza, dolomita, granito, roca volednica, arena, gravy y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanileria, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito,roca volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la coal puede
contener mas de 0.025% de silicio cristalino.
1CUIDADO!
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritacion en los ojos, quemaduras en piel y Ojos, y
reacciones alergicas en la piel. Concreto seco y polvo de agregados,pueden causar irritacion en los ojos,piel y/o en
la zona respiratoria. Polvo del manejo en el tritu.ramiento, pulido, torte y/o perforation puede contener materiales
silicos,los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos,mantenerse
en temperatura cauda,reposar y tomar grandes cantidades de agua.Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la liberation del amoniaco. La inhalation del amoniaco puede causar toner, irritacion o
quemaduras en la nariz, garganta y pulmones.Acirdir i_nmediatatnente 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 con la piel. Use guantes,proteccion en los ojos y ropa
Primeros adecuada para proteccion.Lavese las manos con Gabon suave y agua despues del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use proteccion respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inm.ediatamente fluya agua en la parte afectada por 1.5 minutos.
Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua.Acuda a atencion medica inmediatamente.si la irritacion.continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston,Texas 77024
02/12 Para mas information visita www.cemexusa.com.
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Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant:
Customer Code' Customer Name: Customer Jab Number: Order Code/Date:
Pro ect'Code:`. .' Pro ect Name: _II'tt'.^;d.i'. .' ! . ;f t'•r '1 (] ' _!.. r
1 1 Project P.O.Number: Order P.O.Number.' "
Ticket Date: Delivery Address:. Map Page: Map/Row/Column:
(tet•_-� r.V.- 1 1•_ f_r.,.___ �.'
Delivery Instructions: Dispatcher:
d.
Ticket Number:
Due On Job:, Slump: Truck Number: Driver Number: Driver Name: End Use:
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LOAD CUMULATIVE ORDERED
QUANTITY QUANTITY QUANTITY
MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
' '
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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 - _ r'1.
Comments:
•. f WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
SIGNATURE
„
Q,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 guarariteed. 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 safely handling information,and.to the material safely data sheets for additional information.
retumed 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.
68UNIVERSAL r is CUSTOMER
This Delivery Ticket incorporates her( y reference Buyer's previously execute( ;dit Application, if any. Seller's Standard
Terms and Conditions, Seller's Quotat if any, and Seller's Order Confirmation („nuiuding limitations of warranties), as if fully
set forth on this Delivery Ticket("Agreement"). Seller will provide the Standard Terms and Conditions upon request. Burrpagrces
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 / 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 fly ash, may contain more than 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 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 warrn, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of amino-
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 soap and water after handling. Avoid breathing dust. If exposed to
dust above recommended limits (see MSDS), 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 wet cement contacts skin,rinse thoroughly with water. Get proper medical attention if irritation persists.
CEMEX, 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 incluye como referencia al. comprador (ya previamente ejecutada en su aplicacl6n de credito); cualquier
terrnino estandar. condiciones del vendedor, propuestas del vendedor y Orden de confirnmci6n del vendedor (con linritaciones y
garantfas),como acuerdo total del ticket de entrega("Contrato").EI vendedor proveerd los t6rminos estindares y condiciones detal-
lados en caso de asi ser requeridos.Con este documento,el comprador acepta los mismos ya antes rnencionados y que las cartidades
y materiales fueron entregados como se expresa en el mismo.Acepta pagar el monto de acuerdo al contrato; al menos que se. identi-
fique con Lina nota al frente de este documento.
AGREGADO_S / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca votcanica, arena. grava y otros
materiales silicios. Los productos de cemento inchryen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo 1P), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolornita.
granite,roca volcanica, arena, grava, y otros materiales silicios.Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mas de 0.025% de silicio cristalino.
1CUIDADO!
Peligros: Mezela de cemento Fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en pie] y Ojos, y
reacciones alergicas en la pie]. Concreto Seco y polvo de agregados,pueden causal-irritaci6n en los Ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforaci6n puede contener materiales
silicon, los((tales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos,mantenerse
on temperatura cauda,reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causa,toser, irritaci6n o
quemaduras en la nariz, garganta y pulmones. Ac•,dir inmediatamente at medico.`El riesgo en la sapid depende en
]a duraci6n y el nivel de ]a exposici6n.
Seguridad: Evite el contacto con Ojos y contacto prolongado con la pie]. Use guantes, protecci6n en los ojos y ropy
Primeros adecuada para protecci6n.Ldvese las manos con jabbn suave y aqua despues del manejo de materiales.Evite inhalar
auxilios: polvos. Si se expone a polvos mas do los limiter recomendados,use protecci6n respiratoria.
Primeros auxilios: En caso de contacto on los Ojos, inmediatamente fluya agua en to par'ie afectacla por 15 minutos.
Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus Ojos, lavelos a fondo con
agua.Acuda a atenci6n medica inmediatamente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston,Texas 77024
02/12 Para mas informaci6n visita www.ceinexusa.com.