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A-1NO 38411VVN831N1
INTERNAL USE ONLY
• Observations - Comments Results
Western Slope Concrete
PO Box 1319 Carbondale, CO 81623
Office:970-963-3973 • Fax:970-963-2412
Plant 001 -Carbondale-0242 County Rd 104, Carbondale,CO 970-963-0180
Plant 002-Dotsero-4155 Hwy 6,Gypsum,CO 970-524-2520 .
Plant 003-Silt-1412 CO, RD,311 -Silt,CO 970-963-0180
PLACEMENT AND JOBSITE CONDITIONS - Circle all that apply
1. Windy — Breeze 7 Still 3. Subgrade — Frozen — Wet — Dry 5. Access Issues — Explain Above
2. Rain — Snow — Hot' 4. Placement Concerns — Explain Above 6. Pump Issues — Explain Above
10-1 Load 10-2 Leave Plant 10-3 Arrive Job Site 10-5 Start D harge 10-6 Finish Diisch, 10-9 Leave Job Site 10-10 Arrive Plant
w
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in the event of delivery beyond curbline,this company will not assume liability for NOTE: This concrete contains correct water contents for strength of mix
{ damage to sidewalk, driveway or other property.The purchaser shall in no event indicated. We do not assume responsibility for strength test when water is
accept deliveries of materials not in accord with the agreement of the parties,but such added at customer's request.
materials shall be refused by the purchaser and returned to the seller with a written
statement of the reason for the refusal thereof.Otherwise,receipt of such materials Because the conditions of use and application of colored concrete are beyond
and the signature of the consignee or the consignee's agent shall preclude any and all our control,Casey Concrete makes no warranty of merchantability or fitness for
claims by purchaser. No cancellation accepted after concrete has been loaded in any particular purpose and expressly disclaims liability for consequential or
carrier's truck at our plant. incidental damages,whether based on warranty or negligence.
Water added on job at customer's request Gal
PLANT YARD TICKET# ORDER# TRUCK# LOAD SIZE MIX SLUMP DATE
CUSTOMER# SOLD TO P.O.# PROJECT#
y... ..ten.. .... .. > t ..
DELIVERY ADDRESS ZONE# USE DRIVER
INSTRUCTIONS
GAL TO CY EST.
GAL TO CY EST.
GAL TO CY EST. "
GAL TO CY EST
LOAD CUMULATIVE I ORDERED PRODUCT UNIT OF UNIT
' QUANTITY QUANTITY QUANTITY CODE PRODUCT DESCRIPTION' MEASURE PRICE AMOUNT
CONTACT WITH WET(UNHARDENED)CONCRETE,MORTAR,CEMENT,OR CEMENT MIXTURES CAN CAUSE SKIN IRRITATION,SEVERE CHEMICAL BURNS OR .: .
SERIOUS EYE DAMAGE.Wear waterproof gloves,a long-sleeved shirt,full-length trousers,and proper eye protection when working with these materials.If you have to stand
• n wet concrete,use waterproof boots that are high enough to keep concrete,from flowing into them.Wash wet concrete,mortar,cement,or cement mixtures from your skin
immediately after contact.Indirect contact through clothing can be as serious as direct contact,so promptly rinse out wet concrete,mortar,cement,or cement mixtures from
clothing.Seek immediate medical attention if you have persistent or severe discomfort.In case of eye contact,flush with plenty of water for at least 15 minutes.Consult a
physician immediately.KEEP OUT OF REACH OF CHILDREN:USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY PURCHASE,USE OR COME
IN CONTACT WITH WET(UNHARDENED)CONCRETE,MORTAR,CEMENT,OR CEMENT MIXTURES.
by:
CUSTOMER COPY