Manyar Smelter Project CONCRETE DELIVERY RECORD PT.

Adhi Karya (Persero) Tbk

POURING DATE: CONCRETE MIX TYPE: A / B / C (fc': ) PAGE OF

LOCATION: SLUMP DESIGN: ± cm
STRUCTURE ITEM: ESTIMATION VOLUME: m3
CUMULATIVE st AIR END OF DELIVERY
NO TRUCK NO. BATCH NO. VOLUME 1 SLUMP 1st TEMP. 2nd SLUMP 2nd TEMP. BATCH TIME SAMPLE REMARK
VOL. CONTENT POURING TIME
3 3
- - - m m cm °C cm °C % hh:mm hh:mm minutes cylinder(s) -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1
2
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7
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15
CONCRETE SUPPLIER: CONCRETE RECEIVER:
MIX DESIGN REFERENCE:
SIGNATURE:
CONCRETE SUPPLIER SUBCONTRACTOR