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0 OTTO ROSAAU& ASSOCIATES, INC. <br /> CONCRETE REPORT <br /> Job Number: Permit Number: <br /> 1 Doi <br /> Project: Client: a <br /> ! .. <br /> Address: Address: <br /> Inspector/Date: Contractor: <br /> .,,DESCRIPTION/LOCATION <br /> r }_ k' <br /> 7`t 'v- 1 <br /> Resteel verified: Date/Checked by: Grade: Manufacturer: <br /> Placement Data Batch Weights per cu. d.-Please circle Design / Actual <br /> Supplier: Cement(lbs/type): , <br /> i� .1 _ <br /> Mix Number: Fine Agg. (lbs): IS C) j <br /> Slump Spec: , �`� Coarse Agg. (lbs/size): <br /> W/C Ratio Spec: 5 Coarse Agg. (lbs/size): f <br /> Air Spec: V\1011 Slag Cement(lbs): <br /> Total Yards: Fly Ash (lbs): I L70 <br /> Placed via: / - Water(Ibs or g v <br /> Consolidated: ( yr✓s / no / Admixtures (specify): <br /> V r�' <br /> Required Strength(psi): <br /> Sampling and Testing Data(ASTM 0172,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. ^N�o. <br /> Weather: Slump Range: Air% Range: <br /> Comments <br /> Other ASTM Methods U(se�d: Conforms ,. Does Not Conform <br /> Inspected by: Reviewed by: <br /> (Stgtrature) <br /> Start Time: Finish Time: <br /> This report applies only to the items tested or reported and is the AXclusive 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-62-05(Rev 05/13) 1 <br /> t <br />