DR1201-LR131023 •
~ DISPATCH LOCATIONS TICKET NUMBER
331 N. Main
p
,\ CONCRETE Euless,TX 76039 111 111111101 11 I
`� 817-8354020
i - / a USCONC"RETE.... company
i. —2-3 1�
`WAKMNO:IRRITATION TO THE SKIN AND EYES:.Contains Portland Cement Wear rubber PROPERTY DAMAGE RELEASE WATER ADDED AT CUSTOMER REQUEST
boots and gloves.PROLONGED CONTACT MAY CAUSE BURNS.Avoid contact with eyes and (TO BE SIGNED IF DELIVERY TO BE MADE INSIDE CURB LINE) EXCESSIVE WATER IS DETRIMENTAL
prolonged contact with skin..In case of contact with skin or ayes,flush thoroughly with water.tt - TO CONCRETE PERFORMANCE.
irritation persists,get medical attention.KEEP CHILDREN AWAY. „Qear Custi ni —(The size and weight of this truck could cause damage to the
CONCRETE IS A PERISHABLE COMMODITY AND BECOMES THE PROPERTY OF TN' emises o Cushy, property if this load is placed where you desire.It is our wish
INSTRUCTIONS MUS BEITELEPHONED PLANT. E OFFICE BEFORE RE LOADING 'RRTTSIG�I sign this RELEASE relieving this supplier and its affiliates s this we are requesting that you (-from any responsibility from x �,,. f 0, IV-,,.'ery Way that we can,but
WE DO NOT GUARANTEE FINISHED RESULTS OBTAINED FROM THIS LOAD OF damage that may occur to the premises and/or adjacent property,buildings,sidewalks, - REQUESTOR'S;NAME
CONCRETE AS MANY IMPORTANT FACTORSAFFECTING THE ULTIMATE QUALITY OF THE drive-ways,curbs,etc.,due to the delivery of this material,and that you also agree to
COMPLETED JOB ARE OUT OF OUR CONTROL.We do not warrant that the concrete can be help the driver remove mud from the wheels of his vehicle so that it will not litter the
used in any particular environment or soil conditions or that the concrete is fit for any particular.use. public street.Further,as additional consideration;the undersigned agrees to indemnify SA
cti
Seleon et the mix design and/or specification of the mix design parameters ere'dell.'the and hold harmless the driver of this truck and this supplier and its affiliates for any and
responsibility of Ne Customer,and we assume no Debility therefore. all damage to the premises and/or adjacent property which may be claimed by anyone FULL LOAD' '/.LOAD %LOAD ''I.LOAD
PLEASE NOTE:THIS LOAD OF CONCRETE IS PRODUCED IN ACCORDANCE WITH to have arisen out of delivery of this order -
STANDARD SPECIFICATIONS FOR READY MIX CONCRETE ASTM. ANY DEICING - _ —
MATERIALS,IMPROPER FINISHING AND LACK OF CURING WILL CAUSE DAMAGE-OR A y - r (GALLONS) - (GALLONS) (GALLONS) (GALLONS)
DECREASE IN STRENGTH. - v /�)/
NOTICE:MY SIGNATURE BELOW INDICATES THAT I HAVE READ THE HEALTH WARNING SIGNED: X (JV - " y TEST RESULTS
NOTICE AND SUPPUERWILL NOT BE RESPONSIBLE FOR ANY DAMAGE CAUSED WHEN VVV ". il
DELIVERING INSIDE CURB LINE Vitt) ' ��`AGREE TO THE TERMS AND CONDITIONS ON WEIGHMASTER CERTIFICATE
REVERSE SIDE.TIME IN EXCESS OF FREE TIME WILL BE CHARGED AT CURRENT DELAY - -
SLUMP CONC.TEMP. AIR%
RATE.ALL C.O.D.DELIVERIES MUST BE PAID IN ADVANCE AND LOAD ACCEPTED BY THIS IS TO CERTIFY that the following described commodity was weighed,measured
SIGNING THIS•DELIVERY TICKET BEFORE POURING. - or counted by a weighmaster whose signature is on this certificate,who is a recognized 'CYLINDERS TAKEN: ❑YES ❑NO
LOAD RECEIVED BY: - Q authority of accuracy,as Prescribed by Chapter 7(commencing with Section 12700)of NAME OF TESTING LAB:
,/} � %' Division of the California Business and Professions Code,administered by the Division
x V f4.0/4 1 v)p-• ► 2 ? i 1 7 of Measurement Standards of the California Department of Food and Agriculture. /ti
CUSTOvIZ"•; )'.`.,F-iii'*$ b.K'. LIP, LI;II, du errotkE(Q ell& DELIVERY ADDRESS
CREEK')IEW AND SRC?YfIL-. LN, OPPE:L_L:.
PE9° "I RIVE RETt INING WALL PES'.Icei9..(17
CUSTOMER P.O.# - SPECIAL INSTRUCTIONS
CUSTOMER JOB ID'#
- '• d (LOAD QUANTITY ORDERED QTY CUMULATIVE QTY, PRODUCT ID - DESCRIPTION UNIT PRICE - r EXTENDED PRICE
e eio 1 6. Pik") do 00 let lett 1504 36017.ip s i 6s t<
1. O ENERGY ENERGY FEE
g,tzi ... E N z �IV rO r rt
E
jy3��A,TCH TIME LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR r LEAVE JOB ARRIVE AT PLANT USAGE CODE SUB TOTAL
•
TOTAL WAIT TIME PREVIOUS TRUCK OAD# SLUMP• MAP PAGE -TIME DUE ON JOB TAX RATE TAX filo DATE .ORDER# PLANT TRUCK# .. DELIVERY.PROFESSIONAL ORDER GRAND TOTAL TOTAL
i...."3--0,.:;1 ..-1. =r 11,95 Pc'59 1.256 HORTON:. L;rf1'1L_
DRUM REV-AT PLANT DRUM REV-.START DRUM REV-FINISH DEPUTY WEIGHMASTER - CONTROL#
STRUNK, KENT
�I ��` IIIIIIII II
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12702166 "
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DISPATCH LOCATIONS TICKET NUMBER
331 . Main
Euless,TX 76039 , -� -�CONCRiETE . 11
a US CONCRETE W company .
t' �
1& ,)3--._13
NARNING:IRRITATION TO THE SKIN AND EYES:.Contains Portland Cement.Wear rubber PROPERTY DAMAGE RELEASE . WATER ADDED AT CUSTOMER REQUEST
wots and gloves.PROLONGED CONTACT MAY CAUSE BURNS.Avoid contact with eyes and (TO BE SIGNED IF DELIVERY TO BE MADE INSIDE CURB LINE) EXCESSIVE WATER IS DETRIMENTAL
xolonged contact with skin.In case of contact with skin or eyes,flush thoroughly with water.If TO CONCRETE PERFORMANCE.
nitation persists,get medical attention.KEEP CHILDREN AWAY. -. Dear Customer-The size and weight of this truck could cause damage to the
CONCRETE IS A PERISHABLE COMMODITY AND BECOMES THE PROPERTY OF THE premises and/or adjacent property if this load is placed where you desire.It is our wish
PURCHASER UPON LEAVING THE PLANT.ANY CHANGES OR CANCELLATION OF ORIGINAL to help you in every way that we can,but in order to doillis we are requesting that you
INSTRUCTIONS.MUST BE TELEPHONED TO THE OFFICE BEFORE LOADING STARTS. sign this RELEASE relieving this supplier and its affiliates from any responsibility from] ,X
damage that may occur to the premises and/or adjacent'reedy,buildings,sidewalks, ,. REQUESTOR'S NAME
WE DO: NOT GUARANTEE FINISHED RESULTS OBTAINED FROM THIS LOAD OF drive-ways, etc., to the delivery of this mate I;.end that you also agree to
CONCRETE AS MANY IMPORTANT FACTORS AFFECTING THE ULTIMATE QUALITY OF THE Ys ry n3 y ag It
COMPLETED JOB ARE OUT OF OUR CONTROL We do not warrant that the concrete can be help the driver remove mud from the wheels of his veh a so that it will not litter the
used in any particular environment or soil conditions or that the concrete is fit for any particular use. public street Further,as additional consideration;the undersigned agree,s to'indemnify SA
Selection of the mix design and/or specification of the mot design parameters are solely the aril hold harmless the driver of this truck and this supplier and its affiliates for any and FULLL�QD %L D '/,I QAD % OAD
respoffibiliy of the Customer,and we assume no liability therefore. •. ' al damage to the premises and/or adjacent properly which may be claimed by anyone ll��f
PLEASE NOTE:THIS LOAD OF CONCRETE IS PRODUCED INIACCORDANCE WITH t ve arisen out of delivery of this order..
STANDARD SPECIFICATIONS FOR READY MIX CONCRETE ASTM. ANY DE-ICING MATERIALS,IMPROPER FINISHING AND LACK OF CURING WILL CAUSE DAMAGE OR A /� // t S) ALLONS) (GALLONS) -(G LONS)
DECREASE IN STRENGTH SIGNED: X F'`^-/ 2 TEST RESULTS
NOME:MY SIGNATURE BELOW INDICATES THAT I HAVE READ THE HEALTH WARNING ��fff{,,,,..ff .rJ/'-f/ i/(5-/
DELVE INGSUPPLIER WILL NOT BERAGREE TO FOR ANY SAND CAUSED WHEN - . I S I f( `
REVERSING INSIDE E CURB LINE AND AGREE T WILL THE TERMS AND CONDITIONS ON , ..,WEIGHMASTER CERTIFICATE `.. - L t I C,,NG.TE P. /`lY ASR%
RATE.ALL SIDE.TIME IN EXCESS
RIE S$OF FREE TIME EIN AL VE CE CHARGED OD AC ENT DELAY - - -
SIGNIALL I COD.DELIVERIES MUST BE PAID U IIN ADVANCE AND LOAD ACCEPTED BY THIS n TO CERTIFY that the following e i nature is o commodity was who is a cognized
SIGNING THIS DELVERY TICKET BEFORE POURING. or counted by a weighmaster whose signature is on this certificate,who is a recognized CYLINDERS TAKEN: 'Y YES ❑NO
LOAD RECEIVED BY: authority of accuracy,as prescribed by Chapter 7(commencing with 12700)of NAME OF TESTING LAB: -
r y� Division 5of the Califomia Business and Professions Code,admlm a Division / r..•X l i.? P j:-: !C D} 7 F N of Measurement Standards of the California Department of Food and, lure. •— LJ !dc) ( 2
CUSTOFiEf I-I-41III I.JPCL.HJl-r,/ J.I'dk.v C` l' 1ssTit ii t - . DELIVERY ADDRESS � 1`�„r-�;
CREEKVIEW AND F?C]Yi=ll . S iiy PPE.L:..[.
P T1� D3RIVE i E`1ciIN.INE- WPII 1_: FfallQQ9.ODE7 ftlK
CUSTOMER P.O.#. SPECIAL INSTRUCTIONS -
j
CUSTOMER JOB ID#
LOAD QUANTITY . ORDERED QTY. CUMULATIVE QTY. PRODUCT ID DESCRIPTION UNIT PRICE EXTENDED PRICE
- r pel 116. !iJel . 16. CIO '10L.1'151Zi 600ti E l -ix
,
3., 00 -FEN V 1 ENV I`1R.C?NM NTA.,' ,'
+`tTCH TIME .LEA E tAN ARRIVE O� - BEGIN POUR FINISH POUR• LEAVE JOB ARRIVE AT PLANT USAGE CODE SUB TOTAL
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TOr{ l,,WAl1cTim.- Pi, .si,71,IOUS TRUCK.,,) ) S LOAD#‘6_,t SLUMP MAP PAGE TIME D,E ON JOB TAX RATE TAX
7 i::::'.5 E� ti... 5 DER_-.1_X 11::
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DATE ORDER# •PLANT' TRUCK# DELIVERY PROFESSIONAL ORDER GRAND TOTAL TOTAL
3-130:•-1.J 1 195 P259 1321. ROBINSON, STCVEi`#
'DRUM REV-AT PLANT DRUM REV-START DRUM REV-FINISH DEPUTY WEIGHMASTER - - - CONTROL#
• STRUNK. VENT
Iii ill 11111111111111111
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t4 �y 12702169
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