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� /� �063 �`" <br /> �!` � - 7EPORT NUMBER yR ---- <br /> �. PflEVI0U5 RP'7 NU. <br /> �— <br /> 1'ACIFIC TI�STIN 1.� BOR�iTONIBS <br /> � H�JIOGRAPIIIC INSPECTION <br /> ENGINEERING CONSULTALION E7IECUTIVE OFFICEA 7FOLOOICAL S1IRVEV6 <br /> INSPECTION <br /> MATERIAL TESTINO 941017TH AVENUE WEST P.O.CALL ItOY.181161t08148]OBflB iblL tEST BORINO9 <br /> SEI1Ti LE,WASHINGTON 08119 �iO1L MECHq�ICS <br /> � � � � � <br /> MAILING � ,/ FEPOFiTED !' ` � ; 'f ., 1 <br /> AD�RESS A���. f �1 ��� 1'•� �/ BY J � /.. �})ATE . . .. � . <br /> ✓.��� �fl�� 1���] '1 �I l �)�)�) �%�� ":� NU B�E��. � NUMB�ER ATE -! /li�l 'II S <br /> L -� L 1' � L r_ � '' � , r � � J ARCHI?ECT �� 1 � i .� <br /> PROJECT ���� � � � �� � �%� �� ' �� � EKGINFEfl L : �- <br /> � � � � • \ NUMBER RD CONTRACTOR � � <br /> LOCATION L �_ . � , � " <br /> CONCHETEINSPECTION RESULTS <br /> ; y, �a� <br /> Number of Cylinders CesC 7 Size: �} �t_ Truck/Ticket Na � ��p ;�� Mark: �, �� � <br /> MI%ING �) DESIGN LI • _ t,O <br /> WEATHER'. � ��i � I� � N�� PLANT , ' � ! . ' �.�%'�r')� STRENGTH 1'c ��'���� . <br /> �/� : ���, _ 4U <br /> CEMENT C'SE AGG. FINE AGG. ADMI%. ('{� <br /> PROPORTIONS L��.��.�SeckdCu.Vtl. l( J Lb�.i��In.M��, ��. Per 5er4 P�r f �.' � � i "`� � <br /> INot Cntl11M By P.T.4b) <br /> � L �/ L EPT. ,__� �I V <br /> TVPEGF CEMENT - :SLUMP I Im. �MEAS.AIR A��UANTITV [u,vd�. <br /> iAMPLING IN ACCOROANCE WITH �/ EMBE�O60IT[MS IN GENERAL <br /> APPLICABLE CODE AND SPEC.7 I '_ 5 COMP.IES WITH APPHOVED PLAN7 � �- � <br /> SAMP�INGf1EPRE5ENTATIVE �� � ALl OETECTED DISCREPANCIES � <br /> OF POUR PI�CEMENT7 . � COHRECT PRIOR TO PLACEMENT7 1 r � <br /> MI%PROPORTIONSVERIFlED WITNESSEOPLACEMENT ACCEPiABLEIN ACCOROANCE r� S <br /> BV6ATCHINGSUPERVISION' / U�/� WITHPROIECTREQVIREMENTSANDCONDITION57 <br /> POUR LOCATION 6 NOTES \ � r� �V 1/E.N� 4 � ��( I�7 � 'J a T ( �)1, � �� J �, <br /> IJITu [ ���' ;_ D N� A� r ��r u� OF T �� l;i '� �. ,a �y� �:�+� (: -'�U' ' � �ASC�L'�� <br /> � � �'��b1 L Iu ( H Tu LI '„ ( S Ar F' o�J, E �� J �� A�l!/� <br /> �' -r� �' . llii �cy� � � �� ti� Eu[ ur oF � ��r � � Tc � �(z)f� E� Cur. ;i��u� <br /> AT H IQ �� �� a�( (� � �; ' (�� r U , �:j) y ,J ,�, � A1 C��.�C i; { � '; LuA�,4'0 <br /> �-� � ' y , a � 0 A� t;L�C (�C� C uLJ �+u A � '' '?, ( �. "� !��;`r 'tiG <br /> -,�._ � � ; �� �+ � �,�, ;��Atirr � � i � �a ��� nu� • ��, � � �'� � � l.��od •.� �:-rr- <br /> �I_ �q �11 �' I � If li _ � 5; �i� �. l `; ��/ � '�( d ! �� ( . 1 �� � �c�� l, ;� p' .�idiF;' <br /> ;,rurU I �'.�;' �,�,r ,4E� � � � � � � � e,, ,' � u ,'� �' �•s //p�� /� <br /> This certification euests to the accurecy of the �esuhs obtained Irom the actuxl t nt perlormed anqipr(dAe /�tiqn�,m�e'd�e with�n the scope <br /> of the wark es definrJ nbove. Certilicntion shell not be construeA to represent ins ectmn, epprova(�atdedhnfk tl/ r,.@ssociated work <br /> or e warrenty of design or warkabiliry o(the specification requiremenls." ' ' `S /1 <br /> FfB o �i�i <br /> C ` � 19d0 � <br /> Certi(ied Report by y ,rY l�F <br /> Paci(ic Testing Leborataries , " �nS . � <br /> Conin � r`C HOUPS M�� ER ERPENSES <br /> 1O� �EVCCCCC COST CODE ON OFF RT OT A�E ' ' KIND AMOUNT <br /> 1!i��. �-t'.J-8� I -/ <br /> � p � �'. 1 i� <br /> . <br /> TIMEUVERIFIEDBV:_ � +' ' - Z ^ �� � <br /> REMARKfr. � ' �• �� � <br /> BILLEO ON INVOICE NO. TOTAL HOURS � �� TOTAL <br /> i � <br />