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OTTO ROSENAASSOCIATES, INC. <br />CONCRETE REPORT <br />Job Number: <br />Permit Number: Cd C3; <br />Project: ''° <br />e t <br />Address: 9 1 <br />—Address: <br />Inspector/Date: j�,- j� y,f _ — <br />Contractor: <br />*xLi �. <br />f.j f I <br />O(A <br />%�r (, <br />v <br />0 A <br />r <br />Resteel verified: Date/Checked by: _ ► . a e <br />Grade: <br />Manufacturer: !� <br />r <br />.a <br />Supplier: <br />r <br />Cement (Ibs/type): lo <br />Mix Number: <br />Fine Agg. (Ibs): 1,5 <br />Slump Spec: <br />Coarse Agg. (Ibs/size): <br />W/C Ratio Spec: <br />Coarse Agg. (Ibs/size): 1, <br />Air Spec: A <br />Slag Cement (Ibs): <br />Total Yards: <br />Fly:Ash (Ibs): <br />Placed via: <br />Water (Ibs or ): <br />Consolidated: ( / no <br />F <br />Admixtures (specify): <br />Required Strength (psi): U© <br />Total # of Samples Cast: <br />Total # of Field Cures: <br />Curing Method/Location: <br />Cast Samples <br />Special <br />Break Days <br />Size <br />Time <br />Made <br />Cubic <br />Yards <br />Water <br />Added <br />to Load <br />C 143 <br />Slump <br />C 231 <br />Air % <br />Test <br />C1064 <br />Conc. <br />Tem <br />Ambient <br />Temp <br />Truck <br />No. <br />Ticket <br />No.� <br />r <br />n <br />` <br />Co' <br />,}Z <br />Slump Range: r Air % Range: <br />Weather: Qvg r ct, <br />Inspected by: / ' 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-62-05(Rev 051-13) <br />