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OTTO ROSEAU&ASSOCIATES, INC. <br /> CONCRETE REPORT 52 /806 <br /> Job Number: \(c.,_C.) d--)r Permit Number: ct )c.LI <br /> Project: 1�(( Client: <br /> �VQC� C(,ir�� \fv � C�t"\ <br /> Address: L``1, _.:Y1. Address: <br /> Inspector/Date: -' \,,,r Contractor: <br /> UESC• " 'TION/LOCATION <br /> ?A_r :.tv.)4, c)te'M\:\ .. , OCIA 1_r1C) ci 1\ 104:t C `Qtc� \ c .((AtL;P <br /> s' X crr `IL\ \ -2,(1\ <br /> ' <br /> G:) ht,t�n�. _. ..\ .,3 `�-c� .\-L( O \(11. 1(_1`' \s)(.- \z C-.4 \NA, r \( , 'c ,( 1‘,n , <br /> G.:, \--\t,NA... s . -'t, , 12`1 .\L1) c.r a \7 \ \? '-.C-M9-015 a \Z(o=CtfoOg — ()\3 <br /> 17-1c C\(0© -0G\ , \Z'.= C kGoi -07_ c, 7 q-C t(aO1—C)5() , t I=CICO - (�\il <br /> Resteel verified: Date/Checked by: E€., 7 7 M I Grade:c6 i Manufacturer: r)t <br /> Placement Data j Batch Weights per cu.yd.-Please circle Design / Actual <br /> Supplier: Cement(lbs/type): L4�U <br /> Mix Number: ,1%3w c c, Fine Agg. (lbs): `CJZK) <br /> Slump Spec: ( A , ` Coarse Agg. (lbs/size): ‘....Ortt -71, isw <br /> W/C Ratio Spec: r-^ Coarse Agg. (lbs/size): -z>d(1 I'� f^ <br /> Air Spec: 1,,y t Slag Cement(lbs): <br /> Total Yards: !( Fly Ash (lbs): 0-:.) <br /> Placed via: n.,�C, _.i !. ; Water(lbs or gal): -�a <br /> Consolidated: ((yes / no ) Admixtures(specify): <br /> Required Strength (psi): -. _ <br /> \ Sampling and Testing Data(ASTM C172,C31) <br /> Total#of Samples Cast: ' 1 Total#of Field Cures: Curing Method/Location: <br /> v. <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 /> N. k-t ..) 1(.:54 \O 5, . 1021 r,` ",' �`�. S c131 Ny:'71 <br /> Weather: Slump Range: - Air% Range: <br /> Comments <br /> Other ASTM Methods Used: Conforms \ Does Not Conform 11 <br /> ` <br /> Inspected by: 1 1\�� 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 (2 ) <br /> 6747 M.L. King WayS.,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) \' <br />