CONCRETE MIXTURE DESIGN TEMPLATE VERSION 9.

23
Contract Number Pin Number Project Ref. No.

Plant Producer/ Location Plant Number 0

Contractor Class of Concrete Strength (psi) 3000 at 28 DAYS Early Str. at

P/S Code Cementitious Materials (cm) Type/Class/Grade Source GS (SSD) Weight, lbs. Volume, ft3
0 Cement
0 Flyash
0 Slag Cement

P/S Code Aggregates Type/Size Source GS (SSD) Weight, lbs. Volume, ft3
0 Coarse Aggregate 1 (CA1)
0 Coarse Aggregate 2 (CA2)
0 Coarse Aggregate 3 (CA3)
0 Fine Aggregate 1 (FA1)
0 Fine Aggregate 2 (FA2)
Brand Name - Product Dosage (oz/cwt) Air Weight, lbs. Volume, ft3
0 Air-Entraining Admixture
---
Water w/cm = 1

P/S Code Chemical and Other Admixtures Brand Name - Product Dosage (units) Design Parameters
0 Type A - Water Reducer Total cm Weight, lbs.
0 Type B - Retarder Total Aggregate Volume, ft3
0 Type C - Accelerator %FA of Total Agg. Vol.
0 Type D - Reducer/Retarder Theoretical Unit Wt., pcf
0 Type E - Reducer/Accelerator Freshly-Mixed Properties
0 Type F - High-Range Water Reducer Air Content, %
0 Type G - High-Range/Retarder Temperature,°F
0 Other (QPL Items) Slump/Flow, in.
0 Other (QPL Items) Unit Weight, pcf
0 Type S - Specific Performance Yield
0 Precast

AGGREGATE DATA
CA/FA 4" 3-1/2" 3" 2-1/2" 2" 1-1/2" 1" 3/4" 1/2" 3/8" No. 4 No. 8 No. 16 No. 30 No. 50 No. 100 No. 200 FM Absorption
CA1 ---
CA2 ---
CA3 ---
FA1 10.00
FA2 10.00

COMPRESSIVE STRENGTH DATA

Sample No. Date Made Date Tested Age, days Length, in. Dia., in. L/D C Area, in2 Load, lbs. Strength, psi Average, psi
0 0.00 0.00 0
0
0 0.00 0.00 0
0 0.00 0.00 0
0
0 0.00 0.00 0
0 0.00 0.00 0
0
0 0.00 0.00 0
0 0.00 0.00 0
0
0 0.00 0.00 0

Remarks: Mix ID:

Technician Name: Certification Number:

 CONCRETE MIX DESIGN CHECKLIST

CONTRACT INFORMATION
Contract
Letting Date
Region
Project No.
Ref. No.
County
Project Manager
Contractor
Same as design contract
Lbs. of cement correct
Certified Concrete Mix Design technican
Certification number

GENERAL CONCRETE INFORMATION

Concrete
Contractor's mix design provided
Class of concrete
Class of flyash
Compressive strength requirements
Compressive strength test results provided
Water/cement ratio is acceptable
Proportion of fines is acceptable
Design air is correct

CEMENTITIOUS MATERIALS
Cement Fly Ash
Source specified Source specified
Product on QPL 15 Product on QPL 16
Certification from producer provided Certification from producer provided
Certified mill test report provided Certified lab test results provided
specific gravity specific gravity

AGGREGATES
Coarse Aggregates Fine Aggregates
Source specified Source specified
Source is approved Source is approved
Lab test results provided Lab test results provided
gradation Gradation
specific gravity Specific gravity
Fineness Modulus

ADMIXTURES
Sources and brands specified
Products on QPL 4

TECHNICIAN NAME: CERTIFICATION NUMBER: