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OTTO ROSENAU& ASSOCIATES, INC. <br /> CONCRETE REPORT <br /> Job Number: Permit Number: <br /> Project: Client: <br /> Address: Address: <br /> Inspector/Date: Contractor: <br /> DESCRIPTION/LOCATION <br /> GCS,\n. <br /> c A\(\ <br /> Resteel verified: Date/Checked by: )_'1 �(� Grade: Manufacturer: <br /> Placement Data Batch Weights-Please circle Design / Actual <br /> Supplier: Cement(lbs/type): <br /> Mix Number: 4:4 `��- Fine Agg. (lbs): <br /> Slump Spec: Coarse Agg. (lbs/size): <br /> W/C Ratio Spec: Coarse Agg. (lbs/size): <br /> Air Spec: Slag Cement(lbs): <br /> Total Yards: Fly Ash (lbs): <br /> Placed via: Water(Ibs or gal): <br /> Consolidated: ( yes / no Admixtures(specify): <br /> Required Strength (psi): <br /> Sampling and Testing Data(ASTM C172,C31) <br /> Total#of Samples Cast: Total#of Field Cures: Curing Method/Location: <br /> Water C 143 C 231 C1064 <br /> Cast Samples Special Time Cubic Added Air% Conc. Ambient Truck Ticket <br /> Break Das Size Made Yards to Load Slump Test Temp Temp No. No. <br /> Weather: Slump Range: Air% Range: <br /> comments <br /> Other ASTM Methods Used: Conforms Does Not Conform <br /> Inspected by: n\ 0o Reviewed by: <br /> (Signature) <br /> Start Time: Finish Time: <br /> This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau&Associates, Inc. Reproduction of this report, <br /> except in full,without written permission from our firm is strictly prohibited. <br /> Page of <br /> 6747 M.L. King Way S.,Seattle,Washington 98118-Phone(206)725-4600 or 1-888-OTTO-4-US--Fax(206)723-2221 <br /> Form No.: INSP-62-04(Rev 09/06) <br />