Laserfiche WebLink
' REP( `NUMBER CR 6i 38VI" <br />1 <br />W. PRE1%10US RP'T NO. <br />I'ACIIFIIC TESTING LABORATORIES <br />ENGINEERING CONSULTATION EXECUTIVE OFFICES <br />INSPECTION 3220 17TH AVENUE WEST P.O. CALL BOX 19125 (206) 282-0666 <br />MATERIAL TESTING SEATTLE. WASHINGTON 98119 <br />RADIOGRAPHIC INSPECTION <br />GEOLOGICAL SURVFYS <br />SOIL TEST BORINGS <br />SOIL MECHANICS <br />MAILING - <br />REPORTED <br />_ <br />ADDRESS - <br />- BY <br />DATE - <br />PERMIT <br />CERTIFICATE _ <br />�_ <br />-' - - <br />NUMBER ' <br />NUMBER " .. <br />L <br />J ARCHITECT <br />PROJECT <br />- - '' ENGINEER <br />PURCH.ORD. - <br />_ - <br />LOCATION -- -' <br />- NUMBER . _ CONTRACTOR J <br />- <br />CONCRETE INSPECTION RESULTS <br />Number of Cylinders Cast: Size: ' ' , Truck/Ticket No. Mark: :" - <br />TEMP. $I t <br />WEATHER <br />- <br />CEMENT <br />PROPORTIONS '(Lbc.. Sacks/Cu. Yd. <br />(Not Certified By P.T. Lob) <br />MIXING 4' • DESIGN <br />PLANT ' - ''` • ' �` STRENGTH Fc <br />C'SE AGG. FINE AGE. ADMIX. <br />Y' Lbt. -. In. Max.Lbs. I - Per Sack Per <br />I <br />TYPE OF CEMENT _ :SLUMP <br />SAMPLING IN ACCORDANCE WITH 1 <br />APPLICABLE CODE AND SPEC.? <br />SAMPLING REPRESENTATIVE �.. <br />OF POUR PLACEMENT? - <br />MIX PROPORTIONS VERIFIED <br />BY BATCHING SUPERVISION? <br />POUR LOCATION & NOTES: - I <br />EST. <br />Ins. MEAS. AIR %QUANTITY <br />EMBEDDED ITEMS IN GENERAL <br />COMPLIES WITH APPROVED PLAN? <br />ALL DETECTED DISCREPANCIES <br />CORRECT PRIOR TO PLACEMENT? - <br />WITNESSED PLACEMENT ACCEPTABLE IN ACCORDANCE ` <br />WITH PROJECT REQUIREMENTS AND CONDITIONS? <br />"This certification attests to the accuracy of the results obtained from <br />of the work as defined above. Certification shall not be construed to <br />or a warranty of design or workability of the specification requirements. <br />Certified Report by <br />Pacific Testing Laboratories <br />Copies <br />to: <br />TIMED VERIFIED BY:_ <br />REMARKS: <br />BILLED ON INVOICE NO. <br />Cu. Ydt. <br />the actual test performed and/ogaeptance <br />eYJak anXallje Ji a scope <br />represent inspection, approval or of other,/asji work <br />C/Ty Q� n 1980 <br />lnSUe <br />t3fY�� <br />■■■■!■■■■®®ate®�� <br />TOTAL HOURS TOTALI <br />