CONCRETE TRUCK AND MIXING INFORMATION

ATTACHMENT TO I.R. NO.:

Project No: HWK973 Reg. No: 20060037498

Project Description: Reconstruction of Fulton Street

Borough: Brooklyn

Contractor: JLJ IV Enterprises, Inc.

Inspector's Name: Yefim Gluzman

Location of Use: S/S Fulton St. Bet. Spencer Place & Claver Place
Curb: Sidewalk: Concrete Base: Structural:

Mixer Type: Ready Mix Other

Load Start End Air Content

Truck or Inspection End Mixing Conc. Cylinder
Size Disch. Disch. Slump if
Ticket No Sticker Batch Revs. Temp. Numbers
C.Y. Time Time Applicable
169373 Y N 11 12:04 95 12:40 1:20 3" 5.20% 75 15A,15B,15C
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N

CONCRETE SPECIFICATIONS: MATERIAL USAGE:

Class of Concrete: _3200PSI______ Batch Report No. = Quantity Dispatched from Plant = 11.0 CY
TESTS: Min Max No. of Tickets = 1 Quantity Received = 11.0 CY
Slump 2" 4" First Ticket No. = 169373 Quantity Used = 11.0 CY
Air 5% 7% Last Ticket No. = 169373 Quantity Wasted/Rejected = -

(FILL OUT "DATA SHEET FOR CONCRETE TEST CYLINDERS")

REMARKS:

THIS REPORT IS NOT REQUIRED FOR DEP PIPE CRADLE/ENCASEMENT

The above described work was incorporated into this project and was constructed in conformance with all plans, specifications,
and standards unless otherwise noted.

Reviewed By:
Inspector's Signature Resident Engineer's Name Date
Concrete Truck and Mixing Information Rev. 10/31/03