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WAL-MART STORES <br /> CONCRETE MIX DESIGN SUBMITTAL,FORM <br /> (Section 03310—Structural Concrete and Exterior Concrete Slabs) Date /G of <br /> PROJECT TYPE: <br /> STORE INFORMATION <br /> STORE# <br /> ADDRESS <br /> CITY,STATE <br /> GENERAL CONTRACTOR <br /> COMPANY <br /> 30BSITE PHONE <br /> PER SPEC 03310, <br /> A. CONCRETE INFORMATION 6% +/-1.5% <br /> Supplier Mix Design# d 3 s6A <br /> Design Strength(fc) 510 6 U i <br /> Water/Cementitious Rati <br /> Total Air Conte S % <br /> Total Est.Volume of Concrete CY <br /> Wallace Design Collective, PC design <br /> o�� � Pc� c1 <br /> ❑ <br /> Concrete Uses/Locations Cynt Approved collective <br /> 0 Appoved as Noted <br /> ❑Revise as Noted and Resubmit <br /> MIX Developed From: ❑Rejected-Resubmit as Specified <br /> ❑Trial Mix Test Data(attach test data) ❑Retained for Records Only <br /> [�Field Experience Review is only for general conformance with the Contract Documents and design concept of the <br /> Project.Review does not authorize extra costs associated with deviations from the Contract <br /> Density Documents.Markings or comments shall not be construed as relieving the Contractor from <br /> compliance with the Contract Documents and Contract Provisions.The Contractor remains <br /> 7t(, responsible for selecting fabrication processes,for techniques of construction,confrming and <br /> Wet J per Dry lam. v Pcf correlating all quail applicable <br /> cnd abl lam, <br /> regulations, <br /> dimensions,Rion,, nd codes. <br /> i des.work with other trades,and for <br /> f compliance with all applicable laws,regulations,and codes. <br /> Slump By BSHONDELMYER DATE 8/29j2023 <br /> (f 1")WITHOUT WR Admixture <br /> " (} l")WITH WR Admixture <br /> B. ADMIXTURE INFORMATION <br /> ASTM Designation Product Dosag (ounces) <br /> Manu facturerA3rand oz/cy oz/cwt <br /> Water Reducing cqqqr. k <br /> it <br /> Accelerating <br /> Retarding <br /> a ►Uvv - &60 )L- t s <br /> 03310-27 <br /> 2101 -248-Kennewick,Washington-21794022 Novem her 3.20 2 <br />