07120154 SI SIGNET FILE
Testing Labs, Inc.
DATE: 3l()�) Q DSA FILE/APPL.NO.
PROJECT NO. Z to So OSHPD NO.
PROJECT: VIUA xI aRA &w, id PERMIT NO. � Z a�
LOCATION:70&C(0, J 0HE5TFA1_, C4),C_"FTIN0 WEATHER: C-L Aa- TEMP:
❑ PROOF LOAD ❑ TORQUE E�- WITNESSING
❑ Testing was performed on the following items. All tests were performed with the following calibrated equipment:
RAM: GAGE: TORQUE WRENCH:
RAM: GAGE: TORQUE WRENCH:
%
tlTELOAD Ib REJ.
LOCATION OF TEST PE/SIZE TESD TOO
TYTAA (PSI) ACC. RETESTL or Ft Lbs GAGE
1 E (o
®; Type o ep,/grout used: _ !ILA E5n'4 S Z7. Method Of
Q c application/cleaning., nM n,; b A
LI
Visual inspection was performed onT, r J*JI;TfLATti,) r--3F 4 WkRA4g.t='U_ 1AAJ IT-A-
i69/,'KI M INI. ELI]?n- Rt s! I NT -71W EX)smm& LT Ih aw (";:jka R
�n T1,10 N>-A I W ATE-0 t'A rG 61;104 F F-01 I I E Oink C �01,Tru_
;�i Cir f iLb(,. 17
❑ Show up/Stand by time. Job Canceled/Delayed due to:
❑ All non-compliance items were brought to the attention of: at the job site.
❑ NON-COMPLIANCE REPORT ATTACHED ❑ ADDITIONAL TESTS ATTACHED
NOTES:
1,
A
To the best of my knowledge, the above WAS'!WAS NOT performed in accordance with the apprLd ai s specific at ons, and regulatory requirements.
Superintendent/Representative: ,Inspector:
t _ l
3121 Diablo Avenue 4741 r'ell Drive#8 520 Mercantile Street#A 310 W 5th Street#203
Hayward CA 94545 Sacramento CA 95838 Cotati, CA 94931 Santa Ana CA 92701
JOB SITE COPY FORM 301
SIGNET
Testing Labs, Inc.
DATE: Z / 0 DSA FILEIAPPL. NO.
PROJECT NO/ OSHPD NO.
PROJECT: 1)II �� AES I S (q l PERMIT N0. n 1 !
LOCATION: �� / WEATHER: CATEMP:
�REBAR ❑ TENDON ❑ TENDON STRESSING
Inspected the placement t EIfJF LING S EEL TENDONS/AB'S/ HD'S/TIE DOWNS for the following location:
Yv _ Q
�r Rt
CDR
❑ Observed post-tensioning operations, measured and recorded elongations of tendons for the following location:
❑ CONCRETE ❑ cip ❑ Pc ❑ PT ❑ SHOTCRETE ❑ NS GROUT
❑ Inspected the batch plant operations. Batch Plant/ Location:
❑ Observed placement of CONCRETE/SHOTCRETE/NON-SHRINK GROUT at the following location:
❑ Cast—set(s)of compressive strength samples. Mix# Total cu. yds. placed
Slump(s): %Air: Unit wt(s):
❑ Show up/Stand by time. Job Canceled/ Delayed due to:
❑ All non-compliance items were brought to the attention of: at the job site.
NOTES:
� ! 1
If , (�
To the best of my knowledge, the above /WAS NOT performed in accordance with the approved plans, speci#ications and egul'�tory requirements.
I I 1
❑ Except As Noted i
Superintendent/Representative: Inspector/Technician:
3121 Diablo Avenue 1417 No. Market Blvd. #1 520 Mercantile Drive #A 1320Sim so r le 8 ropolitan Dr. #205
Hayward CA 94545 Sacramento CA 95834 Cotati CA 94931 Anaheim,ICA 92806 a t Diego CA 92108
(510)887-8484 (916)568-5858 (707)665-3950 (714)399-1500 (619) 682-3820
JOB SITE COPY FORM#304(REV 01/08)
SIGNET FILL
Testing Labs, Inc. L'l-l"�
DATE: �J 1-7 / �Q DSA FILE/APPL. NO. l�
PROJECT N0. ��cSn -fir l�1�/n��-7Z OSHPD N0. /�
PROJECT: V I LLA , ) EET9A At'I > &Y,. � /3 PERMIT NO. I� �I Sit
LOCATION:76_�OO 44-0HF_'�7�dh 0). CUFt—,V-n 1 WEATHER: ( � -� TEMP:
.D' REBAR ❑ TENDON ❑ TENDON STRESSING
J5k— inspected the placement'o•f'REINFORCING-STEEL/TENDON /AB'S/HD'S/TIE DOWNS for the following location:
\nl AT-r_7P_ 4 � C BwEr T:--o )lv�70'l
❑ Observed post-tensioning operations, measured and recorded elongations of tendons for the following location:
.®' CONCRETE �S7'cip ❑ Pc ❑ PT ❑ SHOTCRETE ❑ NS GROUT
❑ Inspected the batch plant operations. Batch Plant/ Location:
-t[]J Observed placement p` f CONCRETE/SHOTCRETE/NON-SHRINK GROUT at the following location:
!S FIE ❑ Cast—set(s)of compressive strength samples. Mix# �� 7t pl Total cu. yds. placed
�
Slump(s): %Air: Unit wt(s):
W
❑ Show up/Stand by time. Job Canceled/Delayed due to:
❑ All non-compliance items were brought to the/ teaattention of: /��� at the job site.
NOTES:—4-- - 0�/ 1 1 Ki T-);:::12Q Ci0�7 H 1 F)-b/T-4 _79 l V:� ,AL1 n G slmVE
n A n
To the best of my knowledge, the above WA\/WAS NOT performed in accordance with the approved plans, specifications, al d regulatory requirements.
❑ Except As Noted
Superintendent/Representative: Inspector/Technician:
3121 Diablo Avenue 1417 No. Market Blvd. #1 520 Mercantile Drive#A 1320 Simpson Circle/' 7580 Metropolitan Dr. #205
Hayward CA 94545 Sacramento CA 95834 Cotati CA 94931 Anaheim, CA 928061 San Diego CA 92108
(510)887-8484 (916)568-5858 (707) 665-3950 (714)399-1500 (619) 682-3820
JOB SITE COPY FORM#304(REV 01108)
SIGNET
Testing Labs, Inc.
March 25, 2010
COPY TO:
CUPERTINO BLDG INSP DEPT MAR 3 U 2010
10300 TORRE AVENUE
CUPERTINO, CA 95014
By
PROJECT: 46225650 VILLA SERRA APARTMENTS BLDG 73
20800 HOMESTEAD ROAD
CUPERTINO, CA 95014
PERMIT NO: 07120154
SUBJECT: WEEKLY SUMMARY OF SPECIAL INSPECTIONS
Special inspections were performed for the above referenced project. The inspections were performed by our
certified inspector(s)as described in the attached daily report(s)week ending 03/12/2010.
The work completed or in progress for this report is in accordance with the approved plans, specifications,and/or any
approved change orders. This is a progress report of our special inspections. A final report will be issued upon
request at the completion of the special inspection/testing requirements provided that all outstanding issues have
been resolved and/or corrected.
Respectfully submitted,
Signet Testing Laboratories,Inc.
Michael Everson
Division Manager
TO: PROMETHEUS REAL ESTATE GROUP I
CC: CUPERTINO BLDG INSP DEPT
CC: 'FILE COPY'
3121 DIABLO AVENUE HAYWARD,CA 94545 MAIN:(510)887$484 FAX:(510)783-4295
Form VT 1001, Rev.4
SIGNET
Testine Labs Page 1 of
�,�J�j
DATE: //i�'2`C' f 1, ZD f STL NO: y02 '5'5100
Z52.�s DISPATCH NO.:
PROJECT: LAS XAIII ?45 _t(-C,0 PERMIT NO.: APPL.NO.: 01-110�2_5
PROD. ADDRESS: SHIFT DAY ❑SWING ❑GRVYD. HOURS:
STRUCTURAL STEEL / WELDING INSPECTION REPORT
�Shop Inspection ❑ On-Site Inspection
�
Contractor: Erector: Fabricator:
Type of Inspection: Continuous ❑ Periodic
❑ After-the-Fact
Material ID ❑ Sampling ❑ High Strength Bolting
❑ Ultrasonic Testing ❑ Magnetic Particle Testing ❑ Penetrant Testing
❑Show-up Time: ❑Stand-by Time: ❑Corrective/Rework Time:
Explain:
Certified Welder(s): ❑ Refer to the attached list. Welding Process: Electrode Type/Dia.
_ �Name(s)-Print Clearly Identification ElSMAW: ��
UNC ('J,AA-L.C>e, I%- � �CFCAW: ' U)'G l'/ &je;
❑GMAW:
❑SAW:
❑ ESW:
Type of welding performed:
No.of welder(s)on job this date?: 2, Fille.SP ❑MP•Penetration:❑PJP ❑CJP
All WPS Sheets Verified: ❑ Yes ❑ No,Explain on page 2. ❑Arc Spot Weld •
p ❑Seam • C3 Shear Stud
Attachment(S): ❑ UT Report(s) • ❑ MT Report(s) • ❑ PT Report(s)
Material ID Sheet(s) • ❑ Sampling Form • ❑ Member Completion Sheet(s).
❑ Exceptions noted,final acceptance is pending written approval of the item(s) noted on
❑ Exceptions noted,final acceptance is pending corrective action of the item(s) noted on
❑ Non-Conformance Report(s)attached:
❑ Request For Information report(s)attached:
Ot
All work inspecteMAS/❑WAS NOT performed in accordance with the DSA approved plans,specifications and
regulatory requi
❑ To the best of my knowledge,the work performed during this inspection period❑WAS/[]WAS NOT performed in
accordance with the approved plans,specifications and regulatory requirements.
Inspector: Representative/Superintendent:
3121 Diablo Ave. 1417 N.Market Suite l
Hayward,CA 94545 Sacramento,CA 95834
+ 0 0 0 0 0 0 0 1 +
• SIGNET Form VT 1003, Rev. 1
Testinz Labs Page Z of
Structural / Welding (Shop) Inspection Report
PROJECT: 2��W._' 6wcxJNSPECTOR: i6kf-6_4 / ,) DATE:
MEMBER INSPECTION ON MEMBER STATUS REMARKS
I.D. QTY. ( X ) Proper Box TYPE
� � m
L a+ 3 3 Qr r1
AO 1014
ru 0
� H
2 L x x .4 AdV) � ,Prq 1V4 , 1
EZ-6040701L 01
-A
a�
CODE: (BC) Box Column (B-W) Beam (welded) (C) Channel (P) Pipe
(WC) W-Column (N-NW) Beam(non-welded) (R) Rectangular
(G) Girder (TS) Tubular Steel Other- Describe
Form VT1005, Rev. 0
Signet Testing Labs Page 3 of S
MATERIAL IDENTIFICATION SHEET
INSPECTOR: A1I614"4eL 645'aj DATE: 31111Z-616
PROJECT:145 4114111r, ���/,', jyy�J FABRICATOR: �E6-';W -�/�G'N
MILL TEST REPORT(s)
MATERIAL TYPE & SIZE HEAT NO. GRADE ACCEPT REJECT
3290gv A; 44.3
EG IW -XlAz,
tt 0 tez��2&
NOTE: 1) You MUST circle/underline each heat number on the Mill Test Report that you
identify.
2) Make sure the grade of material is the exact grade called for on the approved
contract dwgs. & specifications. If the Fabricator is substituting one grade for
another(Example: A572 Gr. 50 for A36) you MUST write an RFI or NCR.
3) Do Mill Test Reports meet contract document requirements? If not, an NCR
shall be issued.
MATERIAL TEST REPORT**
ANes Tuba (Arkaraea) Ino. Ref.81L: '80255520
5000 N. County Rd. 967 Date: 09.26.2007
Bfyritsvills. Arkansas, USA CUStamer: 3061
72316
Tel: 619.738.6000
Fax: 519-738-3537
Sold to 2j v
• Shioned to
Valle Iron, Inc. (Part Shcs) Valley Iron No Sierra West
PO BN CA BN SF SPUR 116763 2474 S.
USA NO CA 93778-2024 FRESNO CA .93726
Materiel: 1.5xl.6xl25x4O'O'O(8x8).DOWN Material No: 15015125 _ Made In: USA
Sales order: 328040 zot (/`p j,�J Purchase Order: 110776
Heat No PCs C Mn P 8 BI Al cu Cb Mo NI Cr V
866876 0.060 1.160 •0.010 0.005 0.022 0.020 0.080 0.000 0.023 0.030 0.030 0.004
Bundle No Yield TenpOa EIn.21n Cerdficauon
908862 070870 Psl 072830 Pal 26 % AST1M A600-03A GR B DOWNGRADE
Material Noter
Sales Or.Nota:
Material: 1.6x1.5x125x40'0.0(8x8).DOWN Material No: 16015125 Made In: USA
Saba order. 32804020t. T Purchase Order: 11 D776
Heat No PCs C Mn P S 81 Al Cu Cb M0 N1 Cr V
866674 0.050x1.200 0.011 0.004 0.027 0.026 0.080 0.000 0.025 0.030 0.030 0.003
Bundle No Yield TensOe Elln.2ir Cettlflcadon
906829 000000 Psi 000000 Pal %
Msterlai Nom:
Serial Or.Nots.
Materld: 1.bx1.6x126x40'0°0(Bx8).DOWN Material No: 16015125 Made In: USA
odes order: 328040 Purchase Order: 110778
Meat do Pea C Mn P S 81 At cu Cb Mo NI cr V
866677 0.050 1.200 0.011 0.005 0.021 0.024 0.080 0.000 0.022 0,030 0.030 0.004
Bundle No Yield Tensile EIn,2in Certification
68
805829 067110 Ps1 0310 Pal 26 96 7� �-
Nlaterlal Note: 11] V
Salol OrAlote: 1
Material: 1.6x1.6x126x40'0'018x8).DOWN Material No: 15015126 Made In: USA
Seise orders 328040 ZOt �1 r r Purchase Order: 110776
Heat o vim• S SI Al Cu Cb Mo NI Cr V
866677 0,050 1200 0.011 0.0115 0.021 0.024 0.080 0.000 0.022 0.030 0.030 0.004 1
Bundle No Yield Tensile E1n.21n Con1floation \
906624 067110 Pal 068310 Pel 25 % ASTM A500-03A GR B DOWNGRADE
Material Note:
Sales Or.Note:
Authorized by Quality Assurance:
The results reported on this report represent the actual attributes of the material furnished and Indicate full compliance with all applicable
specification and contract requirements.
Page : 2 Of 17
• V
t0/800® `xlla ES191 ons LODZ/SZ/60
r
CERTIRED MILL TEST REPORT l
)USTUMER VALLEY IRON INC (CMTR) oat -
3114 S. CHERRY AVS. asCAde steel rolling mills, inc. 1-19-10
FRESNO, CA 93706 3200 NORTH HIGHWAY 99W 6U0FlADiMN4 9086$570
MQUIHNYILLE,OREGON 97128
(5q 4r,1-4181 FAX( 0"739 PAGE 1 OF
HNO./PRODUCT/GRADE YIELD TRUSS 314MO. NOM. wr
5 208
1 1 36/44 GRADE FLATS 48.8 69.5 29 99U36, 40-21, 44W
j
51.0 70,5 29
607808
114- Y 1 1/4 36/44 FLATS 50.0 67.5 26 96
48.9 68.0 28
� 8 _
i
1 36/44 FLATS 49.8 71.0 26 95
49.0 70.5 27
ae(:!% 22 36/44 BIJITBRA116, 40-21 44W 50.5 J 73.0 30 99
50.5 72.5 29
f61Aao8 ,
1 4 8 4 -6/44 FLATS 46.7 71.0 31 98 j
45.9 70.5 33
HEAT NO. C i Mn t P 4 S it Si i Cu IF Ni 6 Cr III Yr No • Sa i Al It Cb t Ti t CE #
.72
.019 _ntA
PO NUMBSR(B): 117642
I 1�
CERTIMEO BY. v `
* SNiJF+ CORM°�T' ��!
ALL MELTING AND M
AC URING PROCESSES FOR THE MATERIALS OCCURRED IN THE UNITED STATES.
CONTINTOM MURPHY, Q.A.M.
OSD ON Nzxr PAG$...
® SIGNET
Testing Labs, Inc.
* 0 0 0illikill 0 0 1 ..
DATE: j l(O /O DSA FILEIAPPL. N0.
PROJECT No. Z_+460 / 5�3 6 OSHPD NO.
PROJECT: SOMI- ' LI.w 14,11 K PERMIT NO. Gl 2-9 2—
LOCATION:
LOCATION: V A Q,Y t"-.2'l� WEATHER: G V TEMP: ¢Q
❑ REBAR ❑ TENDON ❑ TENDON STRESSING
❑ Inspected the placement of REINFORCING STEEL/TENDONS/AB'S/HD'S/TIE DOWNS for the following location:
❑ Observed post-tensioning operations, measured and recorded elongations of tendons for the following location:
CONCRETE CkciP ❑ Pc ❑ PT ❑ SHOTCRETE ❑ NS GROUT
❑ Inspected the batch plant operations. Batch Plant/Location:
Observed placement o4LrNCRETE SHOTCRETE/NON-SHRINK GROUT at the following location:
r[ 6 L I baWakocm -
U-4- tri L4101 —
` L
A.
— Cast 2--set(s)of compressive strength samples. Mix# 4 L4 111 f 14- 4-+'7L6 Total cu.yds. placed
Slump(s): 8 (m %Air: _ Unit wt(s): r
ElShow up/Stand by time. Job Canceled/Delayed due to:
❑ All non-compliance items were brought to the attention of: at the job site.
NOTES: L L S
ce it G J c4, t
To the best of my knowledge, the above AS I WAS NOT performed in accordance with the approved plans, specifications, and regulatory requirements.
2eept As Noted
Superintendent/Representative: Inspector/Technician:
3121 Diablo Avenue 1417 No. Market Blvd. #1 520 Mercantile Drive#A 1320 Simpson Circle 7580 Metropolitan Dr. #205
Hayward CA 94545 Sacramento CA 95834 Cotati CA 94931 Anaheim, CA 92806 San Diego CA 92108
(510)887-8484 (916)568-5858 (707)665-3950 (714) 399-1500 (619)682-3820
SIGNET
Testing Labs, Inc.
•. ..
DATE: 2/I0//o DSA FILE/APPL.N0. o 0 0 0 0 0 o i
PROJECT N0. z" +¢�� $ rj'j,3� OSHPD NO.
PROJECT: Sod+ `mow k1QL/ VV/ PERMIT NO.
LOCATION: (JG A e Yke` WEATHER: G/�y TEMP:
(?� REBAR ❑ TENDON ❑ TENDON STRESSING
Inspected the placement oINFORCING STEEL E ONS/AB'S/HD'S/TIE DOWNS for
fo/r�he following location:
B.
�vDLL ♦ ny f0 Ll
U-11ak. YOW C, fo — L 0.
W e ►
Its' vo I-- C — !� I L l o. ll`
*- o w re
❑ Observed post-tensioning operations, measured and recorded elongations of tendons for the following location:
❑ CONCRETE ❑ clP ❑ Pc ❑ PT ❑ SHOTCRETE ❑ NS GROUT
❑ Inspected the batch plant operations. Batch Plant/Location:
❑ Observed placement of CONCRETE/SHOTCRETE/NON-SHRINK GROUT at the following location:
❑ Cast—set(s)of compressive strength samples. Mix# Total cu. yds. placed
Slump(s): %Air: Unit wt(s):
❑ Show up/Stand by time. Job Canceled/Delayed due to:
❑ All non-compliance items were brought to the attention of: at the job site.
NOTES:
To the best of my knowledge, the above AS WAS NOT performed in accordance with the approved plans, specifications, and regulatory requirements.
O Except As Noted
Superintendent/Representative: Inspector/Technician:
3121 Diablo Avenue 1417 No. Market Blvd. 111 520 Mercantile Drive#A 1320 Simpson Circle 7580 Metropolitan Dr. 11205
Hayward CA 94545 Sacramento CA 95834 Cotati CA 94931 Anaheim, CA 92806 San Diego CA 92108
(510)887-8484 (916)568-5858 (707)665-3950 (714)399-1500 (619) 682-3820
SIGNET
Testing Labs, Inc.
* o 0 0 0 0 0 0 •t ..
DATE: Q DSA FILE/APPL. NO.
PROJECT NO. Z 5553 OSHPD NO.
PROJECT: �aa,1L 1 ,�l PERMIT NO. L 3 ,0
LOCATION: �J� 2✓/z'e'[f2-c- WEATHER: G ed TEMP: ¢D
.575
9 REBAR ❑ TENDON ❑ TENDON STRESSING
Inspected the placement TENDONS/AB'S/HD'S/TIE DOWNS for the following location:
ns
c t) 4 �—o L✓,5 D L ♦rfJ
0 Q
La, f, P
❑ Observed post-tensioning operations, measured and recorded elongations of tendons for the following location:
❑ CONCRETE ❑ ciP ❑ Pc ❑ PT ❑ SHOTCRETE ❑ NS GROUT
❑ Inspected the batch plant operations. Batch Plant/Location:
❑ Observed placement of CONCRETE/SHOTCRETE/NON-SHRINK GROUT at the following location:
❑ Cast—set(s)of compressive strength samples. Mix# Total cu. yds. placed
Slump(s): %Air: Unit wt(s):
❑ Show up/Stand by time. Job Canceled/Delayed due to:
❑ All non-compliance items were brought to the attention of: at the job site.
NOTES:
To the best of my knowledge, the abov I WAS NOT performed in accordance with the approved plans, specifications. and regulatory requirements.
❑ Except As Noted
Superintendent/Representative: Inspector/Technician:
c
e��-- L"
3121 Diablo Avenue 1417 No. Market Blvd. !l1 520 Mercantile Drive #A f3jb Simpson Circle 7580 Metropolitan Dr. 11205
Hayward CA 94545 Sacramento CA 95834 Cotati CA 94931 Anaheim, CA 92806 San Diego CA 92108
(510)887-8484 (916)568-5858 (707)665-3950 (714)399-1500 (619) 682-3820
SIGNET
Testing Labs, Inc.
DATE:
3 e DSA FILE/APPL. NO. O O 0 0 0 0 0 1 +
//
PROJECT N0. � �P SO OSHPD NO.
PROJECT: jLLA bEkRAAM. P)LW, PERMIT NO.
LOCATION; e-1022POME$rFAb QDr 6_FMTINO WEATHER: C-LEA 2_ TEMP:
❑ PROOF LOAD ❑ TORQUE L�' WITNESSING
❑ Testing was performed on the following items. All tests were performed with the following calibrated equipment:
RAM: GAGE: TORQUE WRENCH:
RAM: GAGE: TORQUE WRENCH:
LOCATION OF TESTTYPE/SIZE %of LOAD ID GAGE(PSI) N
TESTED TOTAL or Ft Lbs ACC. RFJ. fR7ETEST
rCN
��� rCH
Type Lgp9�C /grout used: ! Z - Method of application/ e�l`a�1�na€�N E:S�CD AlR'
Visual inspection was performed on �F— 1 4 �I? FkT F_" W lrt .
&';1J Him. Ck99r-tom i I N To 7-HE Ext sn a(.- && A-r- 1� ',� nN CE&DEX
W E
OF • 3 L
❑ Show up/Stand by time. Job Canceled/Delayed due to:
❑ All non-compliance items were brought to the attention of: at the job site.
❑ NON-COMPLIANCE REPORT ATTACHED ❑ ADDITIONAL TESTS ATTACHED
NOTES:
To the best of my knowledge, the abo a WAS/WAS NOT performed in accordance with the p r v d I n , pecif a i s, and regulatory requirements.
Superintendent/Representative: Inspector:
3121 Diablo Avenue 4741 Pell Drive#8 520 Mercantile Street#A 310 W 5th Street#203
Hayward CA 94545 Sacramento CA 95838 Cotati, CA 94931 Santa Ana CA 92701
SIGNET
Testing Labs, Inc. 0000000 , ;
DATE: 3 Z A O DSA FILE/APPL. NO.
PROJECT N 5 OSHPD NO.
MA PROJECT: , 7 14) PERMIT NO. QLOCATION: WEATHER:
TEMP:
REBAR ❑ TENDON ❑ TENDON STRESSING
Inspected the placement vnNFORCING STM`TENDONS/AB'S/HD'S/TIE DOWNS for the following location:
� L -
❑ Observed post-tensioning operations, measured and recorded elongations of tendons for the following location:
❑ CONCRETE ❑ clP ❑ Pc ❑ PT ❑ SHOTCRETE ❑ NS GROUT
❑ Inspected the batch plant operations. Batch Plant/Location:
❑ Observed placement of CONCRETE/SHOTCRETE/NON-SHRINK GROUT at the following location:
❑ Cast—set(s)of compressive strength samples. Mix# Total cu. yds. placed
Slump(s): %Air: Unit wt(s):
❑ Show up/Stand by time. Job Canceled/Delayed due to:
❑ All non-compliance items were brought to the attention of: at the job site.
NOTES:
To the best of my knowledge, the ab a WA /WAS NOT performed in accordance with the approved plans ec fi ion , and gul t ry requirements.
❑ Except As Noted
Superintendent/Representative: Inspector/Technician:
3121 Diablo Avenue 1417 No. Market Blvd. #1 520 Mercantile Drive #A 1320 'm so 8 etr politan Dr. #205
Hayward CA 94545 Sacramento CA 95834 Cotati CA 94931 Anaheim CA 92806 Di o CA 92108
(510)887-8484 (916)568-5858 (707) 665-3950 (71 4)399 1500 (619)682-3820
. .ten :v