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51.5276 <br /> GEOT E S T I O' @k Harbor <br /> Bellingham I Arlington Oak Harborr <br /> vm w.geotest-inc.com <br /> i� <br /> ADHESIVE ANCHOR INSPECTION REPORT <br /> PROJECT: 11929 Evergreen Way JOB#: 22-0851 <br /> ADDRESS: 11929 Evergreen Way, Everett, WA REPORT#: AA003 <br /> PERMIT#: B2202-020 DATE: 9/30/2022 <br /> CLIENT: Otak, Inc. PAGE#: 1 of 2 <br /> CONTRACTOR: Otak, Inc. INSPECTOR: Scott Milligan <br /> Items) Inspected Location <br /> 1/2"Hilti HA-E-55 SB Station on Evergreen Way Near Intersection with Airport Road(64 Anchors) <br /> Reference Drawing(s): Windscreen Base Plate Connection Detail on Sheet F1.02 <br /> Items) Inspected -16 Comments <br /> Base Material Condition Dry and Sound Concrete <br /> Drill Bit Type Carbide Bit <br /> Hole Diameter/Depth /� 5/8"/4"and 9" <br /> Hole Cleanliness Blown Out <br /> Anchor Spacing/Edge Distance /� Per Plans <br /> Anchor Type /� Hilti HA-E-55(F1554 Grade 55) <br /> Anchor Diameter/Length 1/2"/4 1/2"and 8" <br /> Anchor Embedment 4"and 8" <br /> Adhesive Type Hilti Hit HY 200-A <br /> Adhesive Expiration Date 05/2023 <br /> Adhesive ICC-ES Report [� 3963 <br /> Other ❑ <br /> The above items were conforming [� Nonconforming Items(see below) ❑ <br /> Comments: GeoTest was on-site as requested for an adhesive anchors inspection at the <br /> above locations. The anchors were installed per the above-referenced drawing and the <br /> manufacturer's installation instructions. GeoTest will return for further inspections upon <br /> request. <br /> COPIES:Jeff.Massie@otak.com Reviewed by <br /> This report shall not be reproduced except in full,without the written approval of GeoTest Services,Inc. <br />