HomeMy WebLinkAbout Flow Fill TicketsCERTIFICATE OF QUALITY
A We guarantee that THIS MATERIAL wi EQUAL OR EXCEED THE QUALITY ORDERED. provided product is ordered and placed w" the cnleda d E the appir"spy and tested to accordance % Arrmcan Society for Testing and Materiels Standards.
1. Conrxae is iumished as ordirg>a Purciraser's specdreations era water is added at jobs ordy at Purchaser s regrest
7 rMlnni'u�n rim M uvrocc M ndrd M miriaY.n�i rFnme
NORTH AMERICA
3 Matariaiprices h*we bad'ing and weighing F.O.9. our plaid but may rat include arty voc" sw" tax. Haul rates will ted be quo for
iNorr The hma prices claged will be those in eW at die tires of the slaprrerd unless specific conwnbr ft are made in advance.
QAD IME, ;
DELIVERY Y AC CESS
ACC ESS
C
361 j L.� L,-
Pud mer is res wmWe to provide sril" approacies to port d delivery.
C onstruction Material
or owner wil be mwmsrble for provdM a proper wash area after ft placement and will not raid Lafarge resporrsrbta for debris, natural or
Tl ab
manmade, on the access medway a delivery is mored inside crab line.
Ptahaseror ` artlar¢ed accepts receipt of this load d Mte W, confems time d arrival, begin unload and firmh times, and has
BEGIN
to�dWatarasfoiow
1
Yds. 1 GaIL Y Gals. Yds. Gals. Yds Gals.
'RESULTS
r Time
Addonal waw added to concrete reduce Its
NOTICE: A FEE OF 52040 L BE CHA EDO ON ALjA*ETURNED CHECKS.
Interest wig be derged on past due_ ' t Est. SDjmp:_
FINJISH
_
SLP
LEAVE
lhffct ser'sSignature
Driver Signature
LOCATION TRUCK CODE
TARE WT. GROSS WE HAULER CODE USAGE
ARRIVE
OUANTITY UOM TICKETED
ORDERED PRODUCT DESCRIPTION PRICEMNIT
EXTENDED AMOUNT
t.5
. ?.v: ftt a' 9 , x - jl ?01_?i" t:), %FJt #;.}
£ mgt (M{ R CUT may.
A0 18. 00 St"ump
IN MILLER !NU
SUBTOTAL
T i. IOPW3SHi=_AD Pi„tVC -L
CARTAGE
3N _ LODGE/COME,
IN BY THE MARklOTT SURCHARGE
DELIVERY
DELIVERY
DATE ORDER CODE
MAP PAGE ZONE CODE PREY. TRUCK ;# SCHD ARVL MIN LD
a tj Zs . i ' d L TAX
I#t
PURCHASE ORDER # CUSTOMER JOB # PICKET AMT.
DEL. AMT.
lONG. `` ; LAT:' TIME LOAD # LICENSE # CART: TAam , DRIVER CODE
- l� ?L ikJ ECT
BEGINNING - ODOMETER - ENDING SP ADDED C 5
lUv
CERTIFICATE OF OUALITY
t
i . We guarantee that THIS MATERIAL will EQUAL OR EX p CEED THE QUALITY ORDERED, v4 ded product is ordered and placed WMM the adena of
LAFA RGE I PP� a a and teste in acca with Scanty tin dd erg and Materials Standards
I Concrete is e furrusteuxx
d audng o Purdnaser's spedficaGOns and water is addedd at job site only at Puxchas aser's request.
-..
c, Ij -- vww ---J -- w,aww.......... —
Material prices include ba ft and weighing F.O.B. our plant but may not Include arty applicable sales tax. Hard rates wM be quoted for
LOAD TIME
AFW 3.
NORTH AM
intim MAW only. The haw prices charged va be ease in effect at the time of the shipnerd unless spelt convnit ends are made In advance.
DELIY'cRY ACCESS
ON JOB
Pordmm is responds to provide suitable approaches to point of day.
Construction Materia
for or owner will be regaWA for providing a pope` wash area after the placement and will not hold Lafarge resporW* for debris, natural or
marrnede, on de access roadway d delivery is required Inside curb line.
Purchaser or bis authorized representative accepts receipt of this bad of maw, confirm tine of arrival, begin unload and fi Wes, and has
BEGIN
instructed the driver to add wafer as fobn:
Yds Gals Yds Gals. Yds. Gals. Yds. Gals
TEST RESULTS
erg
NOTICE: water added to comxete w# reduce its sbtfr.
NOTICE: A FEE OF 520.00 VBLL BE CHARGED ON ALL RETURNED CHECKS.
FINISH
Temp Time
I coil be dnarged on past due accounts. EsL Slump:
% Air SLP
Purdrasees Signature
LEAVE
LAB
Driver ftnature
LOCATION TRUCK CODE
TARE WT. GROSS WT. HAULER CODE USAGE
ARRIVE
t_� 1 ,: r :: ,i }.
QUANTITY UOM TICKETED
ORDERED PRODUCT CODE DESCRIPTION PRICE(UNIT
EXTENDED AMOUNT
f1
tt l t t 6?ty?t s ;.. 3.1? ..I, €► fl; 4tf_= C UT �"` «OF .g
a <. 4.Y t °j P
To
i a�u.`, f 1 i L_E R DAL-
SUBTOTAL
_ s LiI °1I +'tor F'i F;`..
CARTAGE
j . f ,,I" 1 'sit,' L OU+ _ t' C'01
i N z ,! E t tri: , l "f' I f. -i I _j SURCHARGE
DELIVERY
DELIVERY
DATE ORDER CODE
MAP PAGE ZONE CODE PREV TRUCK # SCHD ARVL TXMW # MIN LD
f7-, f f3
TAX
CUSTOMER # PROJECT #
PURCHASE ORDER # CUSTOMER JOB # TICKET AMT.
. AM, 4 :Ill e :.
DEL AMT.
LONG. LAT.
TIME LOAD # LICENSE # CAR7: TABLE '' DRIVER CODE':'
l £C
ENDING SP ADDED
BEGINNING - ODOMETER
-
I�t�
33415 Hwy 6
P.O. Box 1729
Edwards, CO
81632
(970) -3371
Fax 56
Fax (970) 569 -3811
JO§ SITE CONDITIONS:
3 FAIR ❑ RAIN/ SNOW
❑ WINDY ❑ FROZEN SUB GRADE
❑ OTHER
CONCRETE DELIVERY TICKET
)ATE
LEAVE PLANT
ARRIVE JOB i
START POUR r'1
FINISH POUR
LEAVE JOB
ARRIVE PLANT
OVERTIME MINUTES
TICKET NUMBER
!
.�
I
(/
L
g
J
O T Y A
LO B T
D R Q
N
x' z � i +ttvnnrt t+rl9�rIPCd1 _
'ir?
-�+Sw!4•��t'�tBE�
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VATER ADDED PER CUSTOMER REQUEST Warnln g:Concrete q uality e eo ardized if driver is instructed to add
3ALLONS OF WATER ADDED ESTIMAT B SLUMP T Q Y ma Y I P
the beyond t designed slump. Concrete design
SUB TOTAL
wa er Increasing slump
strength may vary significantly from in-place strength depending on placement,
consolidation, curing, and protection of the concrete after delivery.
SALES TAX
:OfJCRETE USEfyiOR DESI)aqSLUMP ORDERED SLUMP YARDS ORDERED TOTAL YARDS DELIVERY REQUEST TIME
WARNING PROPERTY DAMAGE RELEASE
DELAY EXPLANATION 1 CYLINDER UNDER TEST TA
IRRITATING TO THE SKIN AND EYES
:ONTAINS PORTLAND CETAENT. WEAR RUBBER BOOTS AND GLOVES. PROLONGED (TO BE SIGNED IF DELIVERY TO BE MADE INSIDE CURB LINE)
1. Job Not Ready 6. Truck Br a Down
:ONTACT MAY CAUSE BURNS. AVOID CONTACT WITH EYES AND PROLONGED CONTACT Dear Customer - The driver of the truck in presenting this RELEASE to you for your
VITH SKIN. IN CASE OF CONTACT WITH SKIN OR EYES, FLUSH THOROUGHLY WITH ,ygnature is of the opinion that the size and weight of our truck may possibly cause
2. Slow Pour or Pump 7. AKatio,
VATER. IF IRRITATION PERSISTS, GET MEDICAL ATTENTION, KEEP CHILDREN AWAY. damages to the premises and/or adjacent property, if we place the material in this
3. Truck Ahead on Job 8.; C
bad where you desire A. It is our wish to help you in every way that we can, but in
;ONCRETE is a PERISHABLE COMMODITY and BECOMES the PROPERTY of the order to do this the driver is requesting that you sign this RELEASE relievin g him
4. Contractor Broke Down ,%9: Other
'URCHASER. Upon leaving the PLANT, ANY CHANGES or CANCELLATIONS of is from an resonsibilit for any damage that may occur to the
)RIGINAL INSTRUCTIONS MUST be TELEPHONED to the OFFICE BEFORE LOADING and t ho supplier y responsibility
i'
5. Added Water 10. Cylinder Taken
'TARTS. premises and/or adjacent property, buildings, sidewalks, driveways, curbs, etc. by
the delivery of this material, and that you also agree to help him remove mud from
1 U Yes IJ No
agrees to py ll costs, iducting reasonable attorneys fees, incurred l
he undersigned a a n
sums owed. the wheels od h}svaflkli so tliat he wNl not iher the pubic street. Fuller, as addNmal
a AEA =
i collecting any considera' the and rsigned agrees to . emnify and hold harmless the driver
UI accounts not paid within' days of tlelivery will bear an interest of 1 -i/2% per month this c c and this wp�lier for any a damages to the premises and/or adjacent o f
RATE).
Slum =
vhich is 18 k (ANNUAL PERCENTAGE propery whin�ymay bedain by afyone to have risen out of delivery of this order.
Jot respons bee for Reactive Aggregate or Cobr Quality. No Claim A lowed Unless Made - - -
SIGNED
- -
d Time Material is Delivered. /
—
Tern —
Testin Xab =
$25.00 Service Charge will be collected on all Returned Checks. -
X '
_zcess Daily Time Charged at S85.001HR.
the undersigned acknowledges that he/she IS the tjuyer or an aumonzeo agenr for me tsuyer anu a reel, tin Ulundi, — V V IV 1 r[\!L IY V IVIDGr\
)f the Buyer, to all of the terms and conditions set forth herein. Refusal to sign this delivery ticket BU acceptance of -
naterial constitutes agreement with terms and conditions above. T h a n k Yo u
1
' Signature: Print Name:
Acknowledgment of receipt - water added - and general terms and conditions shown on back of ticket.
B &-9
E"AVATING
.jc SVPP
33415 Hwy 6
P.O. BOX 1729
Edwards, CO
81632
Ph. (970) 926 -3371
F ax( 97 0)569 -3811
JOB SITE CONDITIONS:
.- 'F AIR ❑ RAIN / SNOW
❑ WINDY ❑ FROZEN SUB GRADE
CONC RETE DELIVERY TICKET
START POUR
J 56 fl
S B
E *;Stal.+ a utf k .r.l�ra
R g i
L
O ;
T h (.
O.
N
lj0 I 1
_...
L ) + '
I .
�z 4
'
W a rnin _': Concrete quality may be jeopardized if driver is instructed to add
wa
I. Increasing si the slump beyond the designed slump. Concrete design
4strength may vary gniticerttlyfrom in -place siren depending on placement,
onsolidation, curing, and protection of the concrete after delive
RD ry,
MP ERED SLUMP O YARnc nonce.. -_
WA
IRRRATING TO WARN AND EYES
'TAWS PORTLAND CEMENT. WEAR RUBBER BOOTS AND GLOVES. PROLONGED
TACT MAY CAUSE BURNS AVOID CONTACT W
1 SKIN. R CASE OF CONTACT WITH SKIN OR EYES, FLUSH THOROUGCHILDREHLY AWgY WITH
=R. IF IRRITATION WITH EYES AND PROLONGED CONTACT
PERSISTS, GET MEDICAL ATTENTION. KEEP N
CRETE is a MERIS — NA
'TS ""' —"`11I be TELEPHONEDto - or UANCELLATIOI S -- f
goad agrees to
ndefsi the OFFICE BEFORE LOADING
acting any sums owed pay all costs, the
reasonable attorneys fees, incurred
.
counts not Paid within 30 days of dlivery will bear an interest of 1-
Is 18% (ANNUAL P ERCENTAGE ' RATE
sponsible for Re ) 1/2 %
Per month
e Material is Deliv �Ag9regate or COlor Quality. No Claim All
00 Service Charge will be collected ° N'ed Unless Made
I D aily Time Charged et $85-D01" On all Returned Checks.
PROPERTY DAMAGE RELEASE
(TO BE SIGNED IF DELIVERY TO BE MADE INSIDE CURB LINE)
Dear customer - The driver of the truck in P this RELEASE to
damages of opinion is f t that the size and weight of our truck may Possibly damages is f t premises You for your
toad where you desire it. It and/or ad" is our cent property if we Place the Y cause
order to do this the driver' I to help in eve
way material i�fhin
this supplier from an r equesting Mt
. a gn this RELEASE Bur< we can '
Premises and /or adjacent y responsibllltY for any damage tha relieving him
ny, the delivery of this material and Mat buildings, sidewalks, drive Y occur to the
the wheels of his vehicle so Mat he wN You atso anree to hel him re , curbs, etc. by
consideration, not Geso-y p move mud hom ned Offt
P th ier for agree � Indemnify and hold har mless • the
SIGNED which y damages to Me Premises and/or adjacent
nsen out of delivery of this order.
r
j.
❑ OTHER
SUB TOTAL
SALES TAX
DELAY
EXPLANATION CYLIp
1 • Job Not Ready
2. Slow Pour or Pump
3. Truck Ahead on Job
4- Contractor Broke Down
5. Added WateF'"
,ndersigned a sh
acknowledges that he /e is the Buyer or an authorized agent! the Buyer and agrees, , on be T
all of the terms and conditions set forth herein. Refusal to sign this delivery ticket BUT acceptance of
reement with terms and conditions above. esting Lab
Buyer, to a =
ial constitutes ag
Thank You!
lerJgment ofveceipt - water added - Print Name:
andgerlerat- termsand- Condltions shown_onback of ticket.,_
cK UNDER TEST TAKEN
6. Truck Broke Down
7. Accident
8. Citation
9. Other
1 0- Cylinder Taken
1 r r
sa41 O nwy Q
P.O. Box 1729
Edwards, CO
81632
(970) 96- 3371
Fax
Y
CONCRETE DELIVERY TICKET
❑ FAIR ❑ RAIN /SNOW
❑ WINDY ❑ FROZEN SUB GRADE
❑ OTHER
ATE
LEAVE PLANT
ARRIVE JOB
START POUR IFINISH
POUR
LEAVE JOB
ARRIVE PLANT
OVERTIME MINUTES
TICKET NUMBER
B
i
S
O T V
D R
O 4l.
J C
B I
O
N
Warning: Concrete quality may be jeopardized if driver is instructed to add
w er Increasing the slump beyond the designed slump. Concrete design
strength may vary significantly from in -place strength depending on placement,
consolidation, curing, and protection of the concrete after delivery.
SUB TOTAL
SALES TAX
WARNING
PROPERTY DAMAGE RELEASE
DELAY EXPLANATION 1 CYLINDER UNDER TEST TAKEN
IRRITATING TO THE SKIN AND EYES
;ONTAINS PORTLAND CEMENT. WEAR RUBBER BOOTS AND GLOVES. PROLONGED
(TO BE SIGNED IF DELIVERY TO BE MADE INSIDE CURB LINE)
1. Job Not Ready 6. Truck Broke Dow
;ONTACT MAY CAUSE BURNS. AVOID CONTACT WITH EYES AND PROLONGED CONTACT
VITH SKIN. IN CASE OF CONTACT WITH SKIN OR EYES, FLUSH THOROUGHLY WITH
Dear Customer- The driver of the rock in presenting this RELEASE to you for your
signature is of the opinion that the size and weight of ourtrudc may possibly rouse
2• Slow Pour or Pump 7. Accident
VATER. IF IRRITATION PERSISTS, GET MEDICAL ATTENTION. KEEP CHILDREN AWAY.
damages to the premises and/or adjacent property, if we place the material in this
load where you desire it. It o every It is wish to help you in eve way that we can, but in
order to do this the driver is requesting that you sign this RELEASE relieving him
3. Truck Ahead on Job 8. Citation
4. Contractor Broke Down 9. Other
;ONCRETE is a PER COMMODITY and BECOMES the PROPERTY of the
'URCHASER. Upon leaving the PLANT, ANY CHANGES or CANCELLATIONS of
ORIGINAL INSTRUCTIONS MUST be TELEPHONED to the OFFICE BEFORE LOADING
and this supplier from any responsibility for any damage that may occur to the
andlor adjacent property, buildings, sidewalks, driveways, curbs, etc. by
5. Added Water 10. C tinder Taken
y
iTARTS.
The undersigned agrees to pay all costs, including reasonable attorneys fees, incurred
premises
the delivery of this material, and that you also agree to help him remove mud from
ic street. Further, as addional
the wheals of his "hide so that he will not Mier the public ti
C) Yes Ll No
n collecting any sums owed.
411 accounts not paid within 30 days of delivery will bear an interest of 1- 112% per month
consideration, the undersigned agrees to indemnify and hold harmless the driver
djacent
of this tru which this sup for any and all damages t a
o
AEA =
which is 18% (ANNUAL PERCENTAGE RATE).
Not responsible for Reactive Aggregate or Color Quality. No Claim Allowed Unless Made
P ro p ert y out o d ofthi
s `"'hick may b�,�lai med by anyone to have risen out of delivery of this orcler.
slum =
at Time Material is Delivered.
SIGNED J< _ �.-
—
Temp–
Testing Lab =
4 $25.00 Service Charge will be collected on all Returned Checks.
X �� �. "�
Excess Daily Time Charged at $85.00/HR.
The undersigned acknowledges that he /she is the Buyer or an authorized agent for the Buyer and agrees, on behalf CONTROL NUMBER
of the Buyer, to all of the terms and conditions set forth herein. Refusal to sign this delivery ticket BUT acceptance of
material constitutes agreement with terms and conditions above. T f 11 h k YO U c
' Signature: Print Name:
Acknowledgment of receipt - water added - and general terms and conditions shown on back of ticket.
KOECIILBIN CONSUILTING ENGINEERS, INC
`d Consulting Georecbntfcal Engineers
REPORT OF CONCRETE TEST CYLINDER DATA
TO:
JOB NO.
DATE:
�-
DAILY REPORT NO.
SHEET OF ='
INVOICE NO.
PROJECT. '),
PLACEMENT LOCATION: r
BATCH TICKET INFORMATION:
5 PL TRUCK NO. f
TICKET NO. t ' MDC DESIGN NO. J " CU. YD.
TIME BATCHED
TAe ARRIVED
TIME PLACED
FIELD TESTING INFORMATION:
. fr
TBNE TEST TAKEN ! r `" :- f SLUMP `� Dc AIR CONTENT I % wEr UNT WEIGHT — ocf SAMPLE TEMP lc ? AIR TEMP /
Tare Wet Weigle Tam Wt .'
Volume ofTm " " ., +
JOB SPECIFICATIONS: SUJMP DE AIR CONTENT
% WATER ADDED AT SITE �
REMARKS:
CYLINDER INFORMATION:
NO. OF <�
CYt�ERS / ' , -, , CAST .
CURING
ff
BGTL CURE t RA F
1
DA AT LAB
DATE STRIPPED BY.
REMARKS.
AGE
DATE
TOTAL LOAD
D
CO
TYPE OF
CYLINDER
CYL.<> M
UNIT WEIGHT
DAYS
TESTED
(L.BS)
)
(SQ.
,)
CI G'W
(LBS) LBS)
(PCF)
DESIGN STRENGTH tr
PSI ® 28 DAYS
PROGRESS REPORT:
77ris form is for preliminary use only. Kocchlein Consulting Engmecrs, Inc., reserves the
--
ftm to stand teat results upon reviews by a Professional Engineer. The iofomnatioo
contained in this form is not conclusive until reviewed and approved in a final report by a
Professional Engineer. This report only relates to the item tested and :full not be
FIELD OBSERVER REPRESENTATIVE
reproduced except in full, w iff out written approval of Koechlein Consulting Engineers, Inc.
33415 Hwy 6 JOB SITE CONDITIONS:
P.O. Box 1729 e
Edwards, CO ,� �❑' FAIR ❑ RAIN /SNOW
81632 ❑ WINDY ❑ FROZEN SUB GRE
Ph. (970) 926 -3371
Fax (970) 569 -3811 ❑OTHER
CONCRETE nAf-1V1=RV TirkRT
DATE
LEAVE PLANT
AR JOB
START POUR
FINISH POW", -
-
LEAVE JOB
.
ARRIVE PLANT
OVERTIME MINUTES
..
TICKET NUMBER
04 f-
S 11 O T 11 {�;Jb•�I._I....�:':t. 0I 3
ORIGINAL INSTRUCTIONS MUST be TELEPHONED to the OFFICE BEFORE LOADING
STARTS.
The undersigned agrees to pay ail costs, including reasonable attorneys fees, incurred
in collecting any sums owed.
All accounts not paid within 30 days of delivery will bear an interest of 1 -1 /2% per month
which is 18% (ANNUAL PERCENTAGE RATE).
Not responsible for Reactive Aggregate or Color Quality. No Claim Allowed Unless Made
at Time Material is Delivered.
A $25.00 Service Charge will be collected on all Returned Checks.
Excess Daily Time Charged at $85.00/HR.
L
O
J A �hli-t :1DF _ � E
B I }...
O
N
rw urrucraryrrau acKnowleages trial he/she is the Buyer or an authorized agent for the Buyer and agrees, on behalf
of the Buyer, to all of the terms and conditions set forth herein. Refusal to sign this delivery ticket BUT acceptance of
material constitutes agreement with terms and conditions above. - <-
Signature: Print Name:
Acknowledgment of receipt - water added - and general terms and conditions shown on
of ticket.
DELAY EXPLANATION / CYLINDER UNDER TE
1. Job Not Ready 6. Truck B
2. Slow Pour or Pump 7. Accidel
3. Truck Ahead on Job 8. Citatior
4. Contractor Broke Down 9. Other
5. Added Water 10. CylindE
Thank You!
j & P.O. Box 1729
om Edwards, CO
81632
Ph. (970) 926 -3371
FaX (970) 569- 381156I1.I9 1
CONCRETE DELWERY TICKET
JOB SITE CONDITIONS:
❑ FAIR ❑ RAIN/ SNOW
❑ WINDY ❑ FROZEN SUB GR/
❑ OTHER
1;.1(.;)E0111.f4 301 ...1.:I:r 1
t;0 (')'1' E 1 :t_)1AF t L._I
�Warning: Concrete quality may be jeopardized if driver is instructed to add
waTlncreasing the Slump beyond the designed slump. Concrete design
strength may vary significantly from in -place strength depending on placement,
consolidation, curing, and protection of the concrete after delivery.
Y.. tuilrl
WARNING
IRRITATING TO THE SKIN AND EYES
CONTAINS PORTLAND CEMENT. WEAR RUBBER BOOTS AND GLOVES. PROLONGED
CONTACT MAY CAUSE BURNS. AVOID CONTACT WITH EYES AND PROLONGED CONTACT
PROPERTY DAMAGE RELEASE
(TO BE SIGNED IF DELIVERY TO BE MADE INSIDE CURB LINE)
WITH SKIN. IN CASE OF CONTACT WITH SKIN OR EYES, FLUSH THOROUGHLY WITH
- WATER. IF IRRITATION PERSISTS, GET MEDICAL ATTENTION. KEEP CHILDREN AWAY.
`
Dear Customer- The driver of the buck in presenting this RELEASE to you for your
signs fure is of the opinion that the size and weight of our truck may possibly cause
CONCRETE is a PERISHABLE COMMODITY and BECOMES the PROPERTY of the
PURCHASER. Upon leaving the PLANT, ANY CHANGES or CANCELLATIONS of
-` ORIGINAL INSTRUCTIONS MUST be TELEPHONED to the OFFICE
damages to the premises and/or adjacent property, if we place the material in this
load where you desire It. It is our wish W help you in every way that we ran, but in
order to do this the driver is requesting that you sign this RELEASE relieving him
and this supplier from
BEFORE LOADING
STARTS.
The undersigned agrees to pay all costs, including reasonable attorneys fees, incurred
any responsibility for any damage that may occur to the
premises and/or adjacent property, buildings, sidewalks, driveways, curbs, etc. by
the delivery of this materiel, and that you also agree to help him remove mud from
in Collecting any sums owed.
Al accounts not paid within 30 days of delivery will bear an interest of 1 -1/2% per month
which is 18% (ANNUAL PERCENTAGE RATE).
the wheels of his vehicle so that he will not litter the public street Further, as additional
consideration, the undersigned agrees to indemnify and hold harmless the driver
of this buck this
.. Not responsible for Reactive Aggregate or Color Quality. No Claim Allowed Unless Made
and supplier for any and all damages to the premises and/or adjacent
property which may be chimed by anyone to have risen out of delivery of this order.
at Time Material is Delivered.
A $25.00 Service Charge will be collected on all Returned Checks.
SIGNED
Excess Daily Time Charged at $85.00/HR.
X
The undersigned acknowledges that he /she is the Buy r r an authorized agent for the Buyer and agrees, on behalf
of the Buyer, to all of ft- ,terms nditions set fgcth efein. Refusal to sign this delivery ticket BUT acceptance of
material constitute a err' t ith t rms a 1 dif
SUB TOTAL
SALES TAX
DELAY EXPLANATION I CYLINDER UNDER TE
1. Job Not Ready
6. Truck B
2. Slow Pour or Pump
7. Accidei
3. Truck Ahead on Job
8. Citatior
4. Contractor Broke Down
9. Other
5. Added Water
10. CvlindE
_70 MIZA
Slum =
Tern =
Testing Lab =
' Signature: -! ' "`'�� n 0 1�� `� Thank You!
� 'F'rint Name:
Acknowledgment of receipt -water added] artd general terms and conditions shown on back of ticket.
t
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S T Y Gf4L_I -.EGO 3- C(° RF"�i:. ?R� IT ICRl q t f�i�t ll i_k._L l Ell t.: [!_. ', L� ak�'i:
L O E I- Z {(�
B ri {', a:�. .t 1. _ I t.�ll`d t J) YI° I'^�d.. �' () .t �. .
D R
O
N
CERTIFICATE OF QUALITY
V u We guarantee that THIS MATERIAL will EQUAL OR EXCEED THE QUALITY ORDERED, provided product is ordered and placed within the criteria of
n I the applicable specification and tested in accordance with American Society for Testing and Materials Standards.
I�N AFARGE -1 C oncrete is furnished according to Purchaser's specifications and water is added at job site only at Purchaser's request.
2. Unloading time in excess is subject to additional charge. /I — 0
0 RTI-I AMERICA 3. Material prices include loading and weighing F.O.B. our plant but may not include any applicable sales tax. Haul rates will be quoted for L TI Esc
information only. The haul prices charged will be those in effect at the time of the shipment unless specific commitments are made in advance.
DELIVERY ACCESS
Purchaser is responsible to provide suitable approaches to point of delivery. ON B T
I f LJ
Construction Materials
Contractor or owner will be responsible for providing a proper wash area after the placement and will not ho d
La arge responsible for debns, natural or
1
man -made, on the access roadway it delivery is required inside curb line.
Pumh his authorize pe&esentative accepts receipt of this load of material, confirms time of arrival, begin unload and finish times, and has
instru e driver toe as follows:
BE(I
Yds. Gals. Yds. Gals. Yds. Gals.
Yds._ Gals.
TEST RESULTS
Additional water added to concrete will reduce its strength.
NOTICE: A FEE OF $20.00 WILL BE CHARGE MN ALOETURNED KS.
FINISH
Temp Time
Interest will be charged on past due accounts J�
Est. Slump:
Air SLP
Purchaser's Slgnaturer'�T
LEAVE
LAB
A U t u
Driver Signature
xi n A n
LOCATION TRUCK CODE
TARE WT. GROSS WT. HAULER CODE
USAGE
ARRIVE
.- 7....
O ut .0
$11 J1
A
0
0
3
o..
olnr;n
t
I
# PROJECT #
i
QUANTITY UOM TICKETED
ORDERED PRODUCT CODE DESCRIPTION PRICE/UNIT EXTENDED AMOUNT
. ._� t1 i r' , a!Y.' `r ?? i 1. r..4 ::ei.y'_ `. L. u y �; I .:i y P1; )E y i j w { !^ .( ti_
r
-F. ,_
9. 0 C y 9. 00 F> f. R500 0 �':' ..1,. L I F D 4 I D I - *_ L 1 V
AIOwl
!7HP4W (_.C71'vS"FRUC'T C'OP 'R48'.90 F UE_,L
9. 00 I --,w 0 10 SLUMP: -ti. 5 F'1`1XJE0156 '93 5 0 1 2 !. y N IE, F1 00,4F .l'.;...._
ARPAE. I.._E 1 t VA [L.
N : E_ R F RLii WES - 'i L_.101 C R F -) D 1_00V r= O'F:` F="i_.1 -M3GE RE:
L.. at '1' a T n e (-. a r i., 'S. E- � t 1 d r S k? 1 @i' C`' 1 ! <'fi 0 I' S j ' a C :t. =i (. ' %: j' i }3 :i
f_`ty.. 1_.rrfst O: 'ijr?7'`: C.: -. z ( }' !'t1.4 L ":t_..,:i r +9a,:
PURCHASE ORDER #
TIME LOAD # LICENSE #
MAP PAGE ZONE CODE PREV. TRUCK # SCHD ARVL
BEGINNING - ODOMETER - ENDING
SP ADDED
SUBTOTAL
CARTAGE
SURCHARGE
DELIVERY
DELIVERY
MIN LD
TAX
CUSTOMER JOB # TICKET AMT.
DEL. AMT.
CART. TABLE DRIVER CODE TOTAL TO COLLECT
- °��4361917
~~'
'
z CERTIFICATE OF QUALITY uct ced within the criteria of
t h a t TH MA TERIA L —
!
� FARGE
LNORTH^^^---'--'
~~ g ua r a nt ee
the applicable specification and tested in accordance with American Society for Testing and Materials Standards.
1 Concrete *m�� according to Purchaser's specifications and water is added at job site o*4 Purchaser's request.
UOM TICKETED
`
� ' time in excess is subject to addifioniii-charge.
3. rices include loading and weighing F.O.B. our plant but may not include any applic&64�ales tax. Haul rates will be quoted for
unless i commitments are made in
LOAD TLIr E
Out�Tl
p ri c es those in effect at the time of the shipment
u
Purchaser is responsible to provide suitable approaches to point of delivery.
ON JOB
�LUMP:4.5
� - Construction Maw=".="s
inside curb line.
-------------------------------------------------------------------------------
:3. 00, cy 9.6�W
RI�5�08
SATURDAY DELI»ERY
ma req uired
Purchaser or his authorized representative accepts ,
BEGIN
instruct"e driver to add water as follows:
Yds. I Gals._ Yds._ Gals.- Yds._ Gals. Yds._ Gals.
rsorn,svun
���ewmn�um�
w/uos CHARGED pm ETURNED CHECK 9.
NOTICE ~'^^---- Est. Slump:
FINISH
uu�u
It'll rn /
" / �
% Air _ SLIP
\_°7--~
Purchaser's Signatu
. um
RUCK CODE
Driver Signature
TARE WT. GROSS WT HAULER CODE 1.16ALitz
ARRIVE
[
UOM TICKETED
ORDERED
PRODUCT CODE
DESCRIPTION PRICE/UNIT EXTENDED AMOUNT
Out�Tl
�LUMP:4.5
' |
|
-------------------------------------------------------------------------------
:3. 00, cy 9.6�W
RI�5�08
SATURDAY DELI»ERY
(PER CY>
uu^u.
|
|
`~
�
" UC rl l -
SI-1 CUT 'R ION CORIFI FUEL
c
.
'
�w*rn
G SUBTOTAL
CARTAGE
DELIVERY
tDATE OR�DER CODE MAP PAGE ZONE CODE PREV. TRUCK # SCHD ARVIL MINLbi:i.,1 LA)
TAX
CUSTOMER # PtROJECT # PURCHASE ORDER CUSTOMER JOB # TICKET AMT
DEL. AMT
`
m �
�
o �
�
-
!
|
' *uu" �
nacn e W �/^ �p ^
04"
| �� � 6 � 92 2
� | asomwwe' ODOMETER 'swo�a SP ADDED �-��"�^�
-- '
�
CERTIFICATE mQUALITY
We guarantee that THIS MATERIAL will EQUAL OR EXCEED THEoUALITY provided product is ordered and placed within the criteria m
PRODUCT CODE
UWARGE
t applic
1 . Con
_—__—
2 . Unloading time in excess is subject to additional charge.
__.... ________________________—____________—____—_______�_________________—_
ANEW NORTH AMERICA
1. Material prices include loading and weighing F.O.B. our plant but may not include any applicable sales tax. Haul rates will be quoted for
LOAD TIME
9.010
friformati n only. The haul prices charged will be those in effect at the time of the shipment unless specific commitments are made in advance.
S UR DELlVERY
(PEH CY>
DELIVERY ACCESS
�
P urch a s e r _-----_— provide suitable approaches to point of delivery.
ON JOB
C~..~t ~~a~~."="s
Contractor or owner will be responsible for providing a proper wash area after the placement and will not hold Lafarge responsible for debris; natural or
7
�
man-made, on the access roadway it delivery is required inside curb line.
Pu r c haser
instry& Jpdriver to add water as follows:
BEGI
Y Gals. Yds.- Gals. Ycls.- Gals.-
�+
TEST RESUL
*w"=�
monce x FEE or*20uo WILL oc CHA9GEC) ON ALL RETURNED CHEIKS.
FINISH
"ontn Temp —rime
Interest will becharged
� %~~ "=
C
"~"
Purchaser's Signature
Driver Signature
_U9qATION TRUCK CODE
TARE VV7. GROSS WT. HAULER CODE USAGE
ARRIVE
|
^'
uv`.u�
*I,,
QUANTITY UOM
TICKETED ORDERED
PRODUCT CODE
DESCRIPTION PRICE/UNIT E)CrENDED AMOUNT
__.... ________________________—____________—____—_______�_________________—_
SLUMP:4.5
�
9.010
RIR5008
S UR DELlVERY
(PEH CY>
�
� 2
`
`
�
�
o
~ �
� |
�uvvu|
onn�
'
RIR488'VI ENVIP CY
SHAW CONS[RUCTION CORlR�89% FUEL `
18.00 / 27.0k) LUMP: 4.5 RMXJE05SD98 ,3/4,NAE
ARRABELE���OJECT/VAIL
ENTER FR(}M WEST LlDNS HEAD CH AND LO�K �OR FLAGGERS BACKINS IN AL SUBTOTAL
CARTAGE
DELIVERY
DATE ORDER CODE MAP PAGE ZONE CODE PREV. TRUCK # SCHD ARVIL MIN L
CUSTOMIER# PROJECT # PURCHASE ORDER # CUSTOMER JOB # TICKET AMT
DEL. AMT
LONG. LAT. TIME LOAD# LICENSE # CART TABLE DRIVER CODE Vt&Ai
��������
B�x�/we'o�m��'�o� SP ADDED r04301918
"it
f�
l�
liLi i'u A A;t Ur QUAUiY �
We guarantee that THIS MATERIAL will EQUAL OR EXCEED THE QUALITY ORDERED, provided product is ordered and placed within t
LAFARGE the applicable specification and tested in accordance with American Society for Testing and Materials Standards. criter}a'of ,
1. Concrete is furnished according to Purchaser's specifications and water is added at job site only at Purchaser's request. J'r
2. Unloading time in excess is subject to additional charge.
NORTH AMERICA I . Material prices include loading and weighing F.O.B. our plant but may not include any applicable sales tax. Haul rates will be quoted for AD TIME
information only. The haul prices charged will be those in effect at the time of the shipment unless specific commitments are made in adva e.
DELIVERY ACCESS
Purchaser is responsible to provide suitable approaches to point of delivery.
Construction Materials Contractor or owner will be responsible for providing a proper wash area after the placement and will not hold Lafarge responsible naturafor
e for debris; ON JOB
man -made, on the accejod wa is required inside curb line. Purch r or his Uho%senative accepts receipt of this load of material, confirms time of arrival, begin unload and finish times, and has
instr tai$ Mover to a ar/as follows:
Yds. ' Gals Yds. Gals. Yds. Gals.
TEST RESULTS Yds. Gals. BEGIN,
Additional water added to concrete will reduce its strength. —
NOTICE: A FEE OF $20.00 WILL BE CHARGED ON AIL TURNED CHECKS.
Temp Time Interest will be charged ! Opt due accounts. y'? , 4 t INISH
%Air SL F ; r Est. Slump. '
Purchaser's Signato
LAB "r gJs
• - -
Dr(ver EAVE
Signature
LOCATION TRUCK CODE TARE WT —
y y , ,� GROSS WT. HAULER CODE USAGE ARRIVE f I '
QUANTITY UOM TICKETED ORDERED PRODUCT CODE PIT EXTENDED AMO
DESCRIPTION RICE /UN
<_
,
1 jr7"
d-
14 .
i{ <<V; e c
I' <3 t.1 +, }ar: � !:iii. ✓•� -<--
i
..
J{ f6- t if t `� , ;t4p:ei • j ; i . - '
-
`i. 1 1' ( Q �•• S Chi t a i£; V
✓
L9 i i't + .. 1 R_' a, 7.a _ i ... .:
DATE ORDER CODE
MAP PAGE ZONE CODE PREV. TRUCK #
;J1= 1-f
SCHD ARVL
CARTAGE
SURCHARGE
DELIVERY
DELIVERY
MIN LD
33415 Hwy 6
• P.O. Box 1729 j40,rr&je es JOB SITE CONDITIONS:
❑ FAIR ❑ RAIN / SNOW
Edwards, CO
81632 0 V. ❑ WINDY ❑ FROZEN SUB GRADE
Ph. (970) 926-3371-
Fax (970) 569-3811 L] OTHER
CONCRETE DELIVERY TICKET
�
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m�
I
ki W U r
nnrtn
LL
T 1�
la
0
0
Z
=1
( ° z
Z
DATE
LEAVE PLA
ARRIVE 1013�
START POUR
FINISH POUR
LEAVE JOB
ARRIVE PLANT
OVERTIME MINUTES
TICKET NUMBER
PR
QUANTITY
DESCRIPTION
UIM
'RICE
.
10
42 69.q
v,
F zr3 C;
a
B
S L. F * (3Gj C. 3 H 1 0 � 1 1
0 T U
L 0 Y
D E P E
R
L
0
c C11 VC1
A
0 T
B I f � f 1
0
N
CUS NUMBER .:`::
SOURCE::
i-:STRUCK'
' " PR IVER,
STOMER PUR[CHAS9,98DER NU1W8
1_3 4
6, C
t , r G' _
PR
QUANTITY
DESCRIPTION
UIM
'RICE
42 69.q
v,
F zr3 C;
a
WATER ADDED PER CUSTOMER REQ
ip
GALLONS OF WATER ADP�D ESTIMATED SLUMP amlink C quality may be jeopardizeqkAf driver Is Instructed to �cld
SQB TOTAL
tar Incinasising the slump beyond the designed slump. Concrete design
strength may vary significantly from In-place sVfngth depending on placement,
SALES TAX
consolidation, curing, and protection of the cone , to after delivery.
CONCRETE USED FOR
DESIGN SLUMP
ORDERED SLUMP
YARDS ORDERED
TOTAL YARDS
DELIVERY REQUEST TIME
WARNING
IRRITATING TO THE SKIN AND EYES
PROPERTY, Cli��AGE I RELEASE
DELAY EXPLANATION CYLINDER UNDER TEST TAKEN
INS PORTLAND T PROL CONTA PO C RUBBER BOOTS AND GLOVES. PROL
CONTACT MAY CAUSE BURNS. AVOID CONTACT WITH EYES AND PROLONGED CONTACT
(TO BE SIGNED IF DELIVERY TO BE MADE INSIDE CURB LINE)
1 . Jo b Not Ready 6. Truck Broke Down.
WITH SKIN. IN CASE OF CONTACT WITH SKIN OR EYES, FLUSH THOROUGHLY WITH
WATER, IF IRRITATION PERSIST GET MEDICAL ATTENTION. KEEP CHILDREN AWAY.
Dear Customer - The drr., of the tmnp4 In presenting this RELEASE to you f or your
is of the
signature op inion its and weight of our truck my po ssibly mum
=1:1
2. Slow Pour or Pump 7. Accident
I
CONCRETE is a PERISHABLE COMMODITY and BECOMES the PROPERTY 'of the
dam ages to the pr . 1 4amid property. If -a place the material in
load it. It is our w
re you desire "h help you a
in
"this way that Y that we can, but in
3. Truck Ahead on Job 8. Citation
PURCHASER. Upon leaving the PLANT ANY CHANGES or CANCELLATIONS of
ORIGINAL INSTRUCTIONS UST be TELEPHONED to the OFFICE BEFORE
to do this the driver is wussfir
order tegr7 L reliev him
ing
and this supplier from
4. Contractor Broke Down 9. Other
STARTS. I LOADING
The undersigned agrees to pay all josts, including reasonable attorneys fees, Incurred
any responsibility for any damage that my occur to the
promises and/or adjacent property, buildings, sidewalks, driveways. curbs, etc. by
the delivery of thVmaterial, and that you also agree to help him remove mud from
5. Added Water 10. Cylinder Taken
Q Yes L1 No
in collecting any sums owed. I
All accounts not rid within 30 da 'of of d%ver will bear an interest of 1 -1/2% per month
which is 18% N �y (ANNUAL PERCEN RA TE).
the wheals of h1s'vehicle so that he will not litter the public street. Further, as additional
oonsid ort, the undersignid agrees to indemnity and hold harmless the driver
% AEA
Slum
Not responsib for Reactive Aggregate Color Quality.
of tit truck and this supplier for any and all damages to the premises and/or adj am I
or No Claim Allowed Unless Made
at Time a is Delivered.
property which may be claimed by anyone to have risen out of delivery of this order.
SIGNED
Temp
A $25.00 Service Charge will be collected on all Returned Checks.
Excess Daityrune Charged at $85.00/HR.
X
Testing Lab
nnn
11.01
f 99 f
The undersigned acknowledges that he/she is the Buyer or an authorized agent for the Buyer and agrees, on behalf CONTROL NUMBER
of the Buyer, to all of the terms and conditions set forth herein. Refusal to sign this delivery ticket BUT acceptance of
material constitutes agreement with terms and conditions above.
Thank You!
S i g nature: Print Name:
Tno
Acknowledgment of receipt - water added - and general terms anM cohditio6s show, on back of ticket.
O
0
SUBtUTAL
CARTAGE
w
SURCKARW
DELIVERY
DELIVERY
MIN LD
TAX '+
TICKET AINT.
DEL
FT
BEGINNING - 1 R ~ - ENDING SP ; C
fi.,
3 . ✓ .7d1t1WAP is lInM,I 11/
'� ..' - `.. _
y t "IJrYoadfnp Zime lR. aaoaalisaalla�t..ggdNqrW�1t�AK, 'Y ':.
$. lYtelB�fel prlcea ineM+de badrp and �.� �(R!'w'^ � 11{9�I flCq lfM�lldB &1�1 l Br681i%. fI�6 MIS b8 g1101� �
"' 11�01111a�Ofl ORIJ�, nlB ill{086 tl8 thafe in ellfect dtl*"*fftshlpm�tmeeeeapeciro OOIMf7�aNfsa9ta Glade al adfl�8e.
. `.
,. ;-
,,..,..y�� �,e. ,
mBr,011l m to plv*b mi0,,.g.,y.,.�.6��,.r a w m O�.I�B�YBI�. � �lew.s,,..,.,.w..i,1s dlI .,.
r; .: t . `" .. ' Q ' Obf Q OaRlef w� tla Iaa�lOfMl�latOf (wt woh am aw the Pal and will not hold Lderp ] lipalla l l X* nalaal Or
6 triictian 1140*ials asa.e r».
(�{
, , �,r» a,lromweynaow�r ash
Pwdmw or W40 atAl a recelPl of thta bed d materiel, aanfema*w daaWY, b!Bh unload and finish time% and hat
iu4uckdlhe dtirarto addrrateras follow
4
Qt.-Y& Gels Y Gak Yda. Gals __
`1
,, . Jf�e� rw�reddydbean asMw in + dfxedaatre rglh. .•,
i ON ALL REIIIRNED CHECK8 - .
•
IM1fe , , .
MtMeeuvril due aocauds ES<. SIU<ep
�M1 Air �_:B�P
PlabUaaere
LtAWE
i) AB . °'yam �--
01�11at
x
TARE WT.: t itJR4'ilVt ` l .. .: CODE USA#
nwam
ARRIVE
_
ORDERED . PRODUCT CODE DE9QN PRICENMT
}k
22.'5 /2. 23 RT+(XUE0GD8A UL RAFLI9FILL,tD►0 , 3l4, AE
r
SLUMP a 4.5
-- --- -
SUBtUTAL
CARTAGE
w
SURCKARW
DELIVERY
DELIVERY
MIN LD
TAX '+
TICKET AINT.
DEL
FT
BEGINNING - 1 R ~ - ENDING SP ; C
we I ft TH16 MATERAL w. EQUAL OR �f(C D THE pm" ii0ldewd w4 P� WNW the gene d
._'} -'. .. . "`
t k(�y0u �
� 11 y 11 � o � 11v y e
�y�
♦'R /..� i���a�yyy-
I. .MJMOm �e ryli RV a'.'...`^At� °.3. wO�OI C4RIOY Y Ob IN`* it r11dvm s. WOK
y
n^ u� 1w
2. Unbali v*mroN reelllleCttOfddderW dasge• ..
3 MOW plow incNde badno end weloAitg F.O.B. our plat but may rat indude any appiceble sales tax Wait rates w8 be 9uded for
- ..
LOAD TIME
FRI CA
i of the s *nmt arises spwft ao am made in adrerres.
f
DEWERY ACCESS
Punk is raspon" to provide sums approodw b point Of mm-
Construction KAa #erials
ormwvbe r for p ` vWq&pf*pvwg* `�'�" wWwM ofhMLdar�er� one fordmft; l'or
k de
merrrnede, on the &caress roadway i mm lwm* wd cuff ire.
Pu h" or Its a towd aompts moW of this bed d mebrial. aadbrrrs *m d wnvo , boon unload and frNsh linft and has
Yrebteaed "4rher to add w
Yds. t "(. J' Yds. Gals Yds. G�la.Yds. Gds
y
TESTRESHLTS �-
r4
addedbwrastawilreduceitsatreop.
NOTICE: A FEE OF $=a WLL BE CHARGED ON ALL R ED CHE S.
;
temp TB!►
Yterest w* be on past due aooamts. Fit. Slump:
7
%Ak _—T - - -.
[ ' A ', f
Pudaueft
DAVE
LAB ` f
C. ✓
Dftw Slpnad>rs
TARE WT. GROSS wl HAULER CODE USAGE
ARRIVE
"U�?M TiCKETED
ORDERED PRODUCT CODE DESCRIPTM PFd(%/UMT
EX'f1 =NDf t?A
111. 00
1 RMXUE@26DBA UL TRAFL OF I LA 200.1 3/4, RE '
'SLUMP: 4. 5
irk
_
k
SUBT ..
CARTAGE' C
SURCHARGE
DELIVERY
#.?ELIYERY.
B EGINNING 'ODOMETER - ENDING.
•41,Ii.Mwi�1i,. iOr�s
itATMACM111 a' ${ Yfectlllriaat'.
'i� `,. '}
wepueran o #W T40
tib eppYr�le spedlicdb►t ePldtb_6N�11 ..
,�.'��y..
t :- YIBfIBd
�t�'omorX6y1.Blaft
Material prices Wkide be" arld mWom pwt bLj m@y M Nr k& ery t m Had aim w>ibe ocled tar
LOAJ�.`RME
NC #i" t
:ra�6 r+od n,6tKrai.6a>6iWwee�,�6�an ae< wett�6ana6an >aee�6unl��sc��6>��•�•.
c o i1 #eriets
�„►10 m 16111i*m �etav ►6umeIe lo�ctrl r •
.00 Slr owner . for prwldNrg of brgrer wedr are6 alter Um placerrrent and wM rat hold La�r9e reapormible for debrm; rrNUrd «
Co *6ft or wm be
�+.oriiiT�M
m6n+ ade, an ft scoeee ma&W Y d*my i6 rarwwirmlae Curb aft
'.
Pumir6agr ar h16 SIX Woman nt , ample n>Fet of ft lead d materiel, = mm time of ar" been Wood End frM times, and tae
.: - .,
t
IndirrAeaihe Wallows:
Y Y � Yde. Gab Yds Gels
.
iESI f 51lLTS
'
ate rduce its streho.
$" Addaml tl water added connate t re
NOTICE: A FEE OF i W 9E CHARGEaON ALL Wn mm CHECKS.
ILL _�Skuep.
FINISH
Tamp TN1rt
Yrlered wE be charged on peat due aocoraNS.
a
% AM 'UP ,__ _
%
LEAVE
716N TRUCK CODS.
TARE W. GRfiSS RAULER CODE USAGE
ARRIVE
Aga 4790140
U(NlA TICKETED
Fl ow
ORDERED PRODUCT CODE ` DESCRIPTION, PRICFJUNIT
EXTENbm
9.25 cy "4: 25
9.2 5/20. 00 RMXUE [3D8A ` UL:TRAF'LOFTLlL 201f, 3/4, AE
SLUMP x:4.5
t
SUBT ..
CARTAGE' C
SURCHARGE
DELIVERY
#.?ELIYERY.
B EGINNING 'ODOMETER - ENDING.
•41,Ii.Mwi�1i,. iOr�s
X Air
LAB
Purchaser's Signature
Driver Signature
LOCATION TRUCK CODE
TARE WT. GROSS WT.
i
ARRIVE
7.
t iL_
CERTIFICATE OF—
QUANTITY UOM TICKETED
ORDERED PRODUCT CODE DESCRIPTION PRICE/UNIT EXTENDED AMOUNT
We guarantee that THIS MATERIAL will EQUAL OR EXCEED THE QUALITY ORDERED, provided product is ordered and placed within the criteria of
LAFARGE
the
Con crete tested in accordance with American Society for Testing and Materials Standards.
1. Con Con crete is furnished according to Purchaser's specifications and water is added at job site only at Purchaser's request.
2. Unloading time in excess is subject to additional charge.
NORTH AMERICA
3' Mat 1 prices include loading and weighing F.O.B. our plant but may not include any applicable sales tax. Haul rates will be quoted for
information only. The haul prices charged will be those in effect at the time of the shipment unless specific commitments are made in advance.
LOAD T
DELIVERY ACCESS
7
' 1
Purchaser is responsible to provide suitable approaches to point of delivery.
O 708
Construction Materials
Contractor or owner will be responsible for providing a proper wash area after the placement and will not hold Lafarge responsible for debris, atural or
{�
man- made, on access roadway it delivery is required inside curb line.
#
Purchase authorized a accepts receipt of this load of material, confirms time of arrival, begin unload and finish times, and has
BEGIN
„It .
:
instru r to er follows:.
Yds. als. Y -- Gels —"" " - - Vds. Gals. Yds. y Gal §:
7wer
__ —
' %' 1
TEST RESULTS
AddiGo added to concrete ' red its strength.
NOTICE. A FEE OF 520.00 CF�ARGECF�Ii RETU�NtED CHECKS.
FI�ISy
Temp Time
ALL
Interest will be charged on pa0 u f / f Est Slump: ;;
f
SURCHARGE
X Air
LAB
Purchaser's Signature
Driver Signature
LOCATION TRUCK CODE
TARE WT. GROSS WT.
HAULER CODE USAGE
ARRIVE
7.
t iL_
QUANTITY UOM TICKETED
ORDERED PRODUCT CODE DESCRIPTION PRICE/UNIT EXTENDED AMOUNT
„It .
:
SUBTOTAL
CARTAGE
SURCHARGE
DELIVERY
DELIVERY
DATE ORDER CODE
MAP PAGE ZONE CODE
PREV TRUCK # SCHD ARVIL
MIN LD
r. <.. ,. f c'
TAX
TICKET AMT.
CUSTOMER # PROJECT # PURCHASE ORDER #
CUSTOMER JOB #
Q1 C_t -. I- R sa z
DEL. AMT.
LONG. LAT.
TIME LOAD # _
LICENSE # C ART. TABLE DRIVER CODE
TOTAL TO,COLLECT
,
BEGINNING - ODOMETER - ENDING SP ADDED a ;.. 1 0
CERTIFICATE OF QUALITY
We guarantee that THIS MATERIAL will EQUAL OR EXCEED THE QUALITY ORDERED, provided product is ordered and placed within the criteria of
�onaete
LAFARGE the I tested in acw ce rd@n with American Society is added and Materials Standards.
1. C a Nmished according to Purchaser's specifications and water is added at job site only at Purchaser's request.
2. Unloading time in excess is subject to additional charge.
3. Material prices include loading and weighing F.O.B. our plant but may not include any applicable sales tax. Haul rates will be quoted for LOAD TIMID
NORTH AMERICA information only. The haul prices charged will be those in effect at the time of the shipment unless specific commitments are made in advance. _.--
DELIVERY ACCESS
Purchaser is responsible to provide suitable approa,bes to point of delivery. JOB
man-made, °, owner � � is requite proper inside w area after the placement and will not hold Lafarge responsible for debris; natural or the access Construction Materials
Purchaser or his authorized representative accepts receipt of this load of material, confirms time of arrival, begin unload and finish times, and has
instructed the driver to add water as follows: BEGIN
yds. Gals. Yds. Gals. Yds. Gals. Yds. Gals.
TEST RESULTS Additional water added to concrete will reduce its strength. )
NOTICE: A FEE OF $20.00 WILL BE CHARGED ON ALL RETURNED CHECKS. FINISH r�G
Temp Time Interest will be charged on past due accounts. Est Slump:
%Air SLIP Purchaser's Signature LEA
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Driver Signature
LOCATION TRUCK CODE TARE WT. GROSS WT HAULER CODE USAGE
QUANTITY UOM TICKETED ORDERED PRODUCT CODE DESCRIPTION PRICE/UNIT EXTENDED AMOUNT
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DELIVERY
DATE ORDER CODE MAP PAGE ZONE CODE P C kf 'ICA&ARW MIN LD
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CUSTOMER # PROJECT # PURCHASE ORDER # ''` --- CUSTOMER JOB #` TICKET AMT.
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LONG. LAT. TIME LOAD # LICENSE # CART. TABLE DRIVER CODE
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