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OTTO ROSENAU& ASSOCIATES, INC. <br /> CONCRETE REPORT <br /> I Job Number: I Permit Number: <br /> Client: <br /> Project: <br /> ;z4:iccirjv47- L 41,i, _ ,) Loi e.`, .i.0 <br /> Address:'/ `�y .2,074�D� ^ S ,-- --' -4-'1 Address: <br /> Inspector/Date: ,' /,..,,, I ` __.i..- 1 Contractor: i-' . ,, <br /> DESCRIPTION/LOCATION ' ' <br /> •Sf>c <.,;a Lc) rt 1 <br /> 6 :, it i i r b,-1 d i /': 17(7,;01,!..-v 6 , <br /> '! / C. <br /> ah� �- fn's{^f ll(:k - )-t-e, e , '15:' 1...r -.f f(((.'". "'i~. b.-, i ic: �t ,-, ;)7-. t I .. <br /> �` /y f r v ~+ <br /> 1 F ) 1l1l)f.• j >- • (C:?t.-�� ,..17 rt 1-7... Ol;"1 f 1 rill r t} . <br /> Resteel verified: ..,/,,, 2- Date/Checked by: . ,+ C;;›,A,, Pt.-I' Grade: Manufacturer: <br /> Placement Data Batch Weights per cu.yd.-Please circle Design / Actual <br /> Supplier: j-1 z {c J Cement(lbs/type): 1 C ,t_ <br /> Mix Number: I c Fine Agg. (lbs): X41 <br /> Slump Spec: 9 '7 ' Coarse Agg. (lbs/size): 14 <br /> W/C Ratio Spec: 6 ...-;'" Coarse Agg. (lbs/size): <br /> F ' `@ir Spec: ! Slag Cement(lbs): <br /> t`ota!Yards: Fly Ash (lbs): 6 <br /> Placed via: !!! µ1- ° Water(lbs or gal): ' <br /> Consolidated: [ ( yes)/ no ) Admixtures(specify): ti <br /> Required Strength (psi): ? ,J,r,y` IP 2 ;ti'- <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 Days Size Made Yards to Load Slump Test Temp Temp No. No. <br /> S <br /> % <br /> Weather: Slump Range: Air Range: <br /> Comments <br /> Other ASTM Methods Used: .. Conforms < Does Not Conform <br /> r fi <br /> Inspected by: 4',j1,h., . • „,_ .-' Reviewed by: <br /> (Signature) <br /> r-'Start Time: t Finish Time: <br /> I <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 frdm 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-4-11a.-Fax(206)723-2221 <br /> Form No.:INSP-62-05(Rev 05/13) C9 41” <br />