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OTTO ROSENAU& ASSOCIATES, INC. <br /> PROPRIETARY ANCHOR ADHESIVE INSPECTION REPORT <br /> Job Number: _;; • Permit Number: <br /> Project: ( I ik.) ) I Client: // <br /> Address: % j()� IA) <'` "�� d`• 1J;.f(: r Contractor: f'_(/4,_1.5..'l,) �e`��... ! •t 1k.J<-i 'to <br /> Inspector: R ` <br /> Date: � ! � i � -,, -77 <br /> DESCRIPTION/LOCATION <br /> .01--)_ . i !' / [% � Lf— •-�'{f ' (-7° o �t t/ A tk ( f M' <br /> e,> C ' C., C t I A��� L.. 51 k 1 r:) "i �: /NJ( <br /> Intended Use: AAA:I" L)l't <. Building Code&Year: <br /> 0 Reinforcing Steel El All Thread <br /> Bar/Dowel Size&Quantity: Anchor Size&Quantity: }/z__ r; (; %/ 1 .. <br /> Rebar Manufacturer: Type of Steel (ASTM): 0 A-36 ❑ F-1554 ❑A-307 <br /> Rebar Grade: 0 40 ❑ 60 0 Other: Grade: ❑ 36 ❑ 50 ❑ 75❑Other: <br /> Type of Bar: ❑A-615 ❑A-706 ❑A-775 ❑ Other: <br /> Special Ductile Quality(SDQ): ❑Yes ❑ No <br /> Anchor Length: ' t 1 Hole Depth: Required Embedment: <br /> Hole Diameter: .5 Concrete Thickness: Concrete Strength: -- <br /> Hole Orientation: ❑Vertical Down ❑Vertical Up ,,Horizontal <br /> Base Material: ,0 Normal Weight Concrete ❑ Light Weight Concrete ❑ CMU ❑ Brick ❑ Composite Deck <br /> Hole Cleaning: •❑Compressed Air ❑ Hand Pump ❑ Other: Compressed Air PSI: /Z c <br /> Brushed: , Yes ❑ No Hole Condition: ,❑Dry ❑ Damp ❑Water Saturated ❑ Submerged <br /> Drill Bit(ANSI B212.15): ❑Yes ❑ No Approved Diamond Cored Hole: ❑Yes .❑"'No <br /> Adhesive Manufacturer/Type: S„ �t j �,, f .t Expiration Date: ICC ESR#: <br /> Weather: / Ambient Temperature: Substrate Temperature: <br /> . <br /> Comments <br /> • <br /> Reference Standard(s)Used: Conforms rr Does Not Conform <br /> 12/ri <br /> Is this a re-inspection? ❑ No ❑Yes- iginal inspection date: <br /> Inspected by: Reviewed by: <br /> Start Time: IFinish 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-86-02(Rev 05/13) ' (� <br />