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tntertek Professional Service Industries,Inc. Report No: SID:07123189-2-01 <br /> 16750 Woodinville Redmond Rd NE Issue No: 1 <br /> Woodinville,WA 98072 <br /> S1 Phone:(425)409-2504 These test results apply only to the specific locations and materials <br /> noted and may not represent any other locations or elevations.This <br /> report may not be reproduced,except in full,without written <br /> permission by Professional Service Industries, Inc.If a non- <br /> compliance appears on this report,to the extent that the reported <br /> Special Inspection Dail Field Report non-compliance impacts the project,the resolution is outside the <br /> PSI scope of engagement.Tests and inspections are considered to <br /> Client: AIRGAS USA LLC CC: be simple acceptance criteria unless noted otherwise. <br /> 11900 NE 95TH ST TOM MATTAM <br /> VANCOUVER, WA 98682 <br /> aril»� <br /> Project: CREATION TECH ANCHORS(AIRG <br /> EVERETT, WA 98203 Approved Signatory: Carlos Perez <br /> Date of Issue: 10/1/2025 <br /> General Details <br /> Date: 9/30/2025 General Contractor: Air Gas <br /> Permits: Tank 2507-004 Weather: Sunny <br /> Type of Inspection Performed <br /> ❑ Reinforced Concrete ❑ Structural Masonry ❑ High Strength Bolting ❑ Fireproofing <br /> ❑ Reinforcing Steel ❑ Soils ❑ Welding ❑� Other <br /> ❑✓ New Inspection ❑ Re-Inspection <br /> Standby Time: <br /> Field Observations & Comments <br /> 0 Special Inspection ❑� Continuous ❑ Periodic <br /> Location(s)/Item(s): <br /> Creation Technology <br /> Reference Details/Drawings: <br /> Everett Permit Service notes cover sheet <br /> Remarks: <br /> Observed the placement of(4) 3/4" diameter 16" long anchor rods HAS-V-36 HDG (ASTM 1554 GR 36. Contractor drilled <br /> 4 holes using a 7/8" diameter drill bit, these holes were 12" deep and all holes were cleaned out per the epoxy <br /> manufactures requirements prior to the placement of the epoxy. the Epoxy was HILTI HIT-RE 200 V3 with an exp date of <br /> 2026/May/31 Lot# 15753068. these bolts were installed at the base of the PERMACYL 5500 VHP N2 TANK. <br /> To the best of PSI's knowledge, the work inspected to the approved construction documents are: <br /> 0 Conforming ❑ Non-Conforming <br /> Inspector: John Cleary Inspector Cert No.: SI 02660 <br /> Jobsite Representative: Wyatt <br /> ©2000-2025 QESTLab by SpectraQEST.com Page 1 of 1 <br />