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I � � RE''7T NUMBER yR r �� � �; � <br /> . u�yr <br /> ' PREVIOUSRP'TNO. � <br /> ��� PACIFIC TBSTIN LARONATODIB� <br /> Re�IOGNAPNICINSPECTION <br /> E�OINEFRINO CONSUITATION EXECUTIVE OFfICES GEULOGICAL 6URVE�6 <br /> INSPECTION �ZpQ.�ytH AVENUE WEST P.O.CALL BO%1B1Y81:!Otl)]Bi-0888 SOIL TEST BOPIN6S <br /> MATERIAL TESTINd 6EATTLE,WASHINGTON9B11B SOIL MECNANICS <br /> r � <br /> � , <br /> MAILING REPORTED <br /> AODF1E55 . • ,__�/'' . . . _ . BV . DATE <br /> � PEPMIT CERTIFICATE <br /> . '1,.t �,�� NUMBER NUMBER <br /> L J ARCHITECT <br /> PPOJECT ' CNGINEER <br /> � PURCH.ORO. <br /> LJCATION - �� . �. NUMBER CONTRACTOR <br /> CONCRETEINSPECTION RESULTS <br /> , Number ol Cylinders Cest ._ Size: � Truck/Ticket No. Mark: ' , <br /> � MIXING DESIGN <br /> TEMP.Q� STRENGTH�'c <br /> WEATHER - PLANT <br /> ICEMENi C'SE AGG. FINE AGG. ADMI%. <br /> � PROVORTIONS �'Lb�. 6�ck�/Cu. Ytl. 'Lb�. In.M�e. Lb�. oo Sv.M Prt <br /> (Not Grtlibd By P.1'. 4b) <br /> EST. <br /> TVPE OF CEMENT ' ' ' ' ;6LUMP . 1 Int. MEnS.AIR , 76�UANTITV , Cu.vtl�. <br /> � SAMPLING IN ACCORDANCE WITH EMBE�DED ITEMS IN GENERAL <br /> APPLICABLE CODE ANO SPEC] COMPLIES WITH APPRDVED PLAN7 . <br /> � SAMPLING REPRESENTATIVE ALL DETECTED DISCREPANCIES � . <br /> OFPOURPLACEMENT7 CORRECTPRIDRTOPLACEMENT7 <br /> � MIXPROPORTIONSVERIFIED WITNESSEDPLACEMENT ACCEPTABLEIN ACCORDANCE _ <br /> i BV BATCHIkG SUPERVISION7 � WITH PFlOJECTf1E0UIREMENiSANOCON�IT10N5� � � - <br /> POUR LOCATION d NOTES'. <br /> "This certificetion ettests to the accurecy of the resuhs ohtained from Ihe ectual test perlormed anA/or o nrrvations made within the scope <br /> of the work es defined nbove. Certification shall not be cons�rued to represent inspection, epproval o � e�{ance ol other Bssocieied work <br /> or e werrenty of design or workabiliry of the specificetion requirements." �,� , , <br /> ���� -� � �� <br /> CertifiedReportby �� �q� <br /> Pacific Testi:,g Leboratories TV _onre • �� <br /> con�.� H�URS M�4E, .OTHER EXPENSES <br /> '° ' '•FC. 1 LV��rCtt m1N :-," �U , �c� � i D AMOUNT <br /> • COST CODE ON OFF R <br /> � <br /> TIMED VEHIFIED BV:__ <br /> REMARKS�. — — 70TAL <br /> TOTALMOURS <br /> BILLBD ON INVOICE NO. — <br /> i ' <br />