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OTTO ROSEIJ& ASSOCIATES, INC.
<br /> CONCRETE REPORT744' `A4
<br /> 9
<br /> Job Number: \ !. J\le Permit Number:
<br /> ° a.1 a :.s +.rte, , ,.4'41P1'� 7$4ti, "a' "��: M *e; : 3.gz r;.
<br /> 4
<br /> Client:
<br /> Project: q.,,,ICr \` V-.-,‘ ,°_, ,twit,; , c.
<br /> Address: Address:
<br /> Inspector/Date: 1 �D�4, ^(\c(,,re Contractor: r) \,, e r~ t
<br /> - �''L 4.f \�'� ir ' \ c e 1 ,' 2. LiiL\ZO
<br /> � � •fie �,� �O 1 �. ,�
<br /> .1`.� - r. It% c 1 .-C:\tW,` L.�\ 23`1 L ` . `\' C,tL S.E. C\fib. - 07-L\
<br /> 'der , '`.a.�: :� •',. t tr�} -y((�((�� (( (^. MM 11 [�
<br /> 5- c L .5 i:.- ' C X 1CLA-C , = c \ \`' ,r,A , \,f' 'C o.6ti ;'c
<br /> Lar‘ G: t_ L \A 3\4\ NL S.C. u .1 iouk_z() ` (L�c� 2(0 Li 911 3t�' i.v �, .L_ C 11 S_.
<br /> \b -f LCA\ Z(cc, L\4c -3,k--, �.�i L. _, .� �. f GcJ (jV�
<br /> - -
<br /> Resteel verified: .\/- Date/Checked by: .t _\--) ,Jot, ('`ivy r Grade: (Al
<br /> gr7p "� Cement(lbs/type): 4\0
<br /> Supplier: 1 c
<br /> Mix Number: \4F>3e>b Fine Agg. (lbs): \7_
<br /> Slump Spec: • . , ``' Coarse Agg. (lbs/size): \cJQ
<br /> W/C Ratio Spec: s3 Coarse Agg. (lbs/size): 'uv
<br /> Air Spec: v:N Slag Cement(lbs):
<br /> \
<br /> Total Yards:Cl L, Fly Ash(lbs): ;;�()
<br /> Placed via: Water(lbs or gal): 3
<br /> kVAI -x (•1(11
<br /> Consolidated: (t...yes / no ) Admixtures(specify):
<br /> Required Strength(psi): k
<br /> ,4 ....'..:.i a.. .: :. ":;,.............,-..-.....�..w 33„ —.:a.: ,,k.:,.:,`v-=- .r,.,4: ..
<br /> Total#of Samples Cast: 1 Total#of Field Cures: ;i Curing Method/Location:
<br /> — — — — Water C 143 C 231 C1064
<br /> Cast Samples Special Time Cubic Added Air% Conc. Ambient Truck Ticket
<br /> Slump Da s Size Made Yards to Load Test Tem. Tem. No. No.
<br /> 6,',,1 N L,y i, 1 i \a \ \(J (, c'"
<br /> Weather ,m.
<br /> ....,....3 --.1 .7., ;:,,,,,, ,.
<br /> �,...,.,.., . .K...w Slump Range: Com, 7kg T Air%!Range:
<br /> SIIM, , .y, sas ? 41.. .!!!'
<br /> F,,
<br /> Inspected by: �; ; '1(J1 '\ 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 ,_ t
<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)
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