Client:

Engineering: Tritoplan Consultants

Address: Testing Lab: Phone #: Date:

Date of Test: Concrete Strength Test Results

Required Test Description Sample Type
Item # Description Date of Pour Time of Pour # of Samples Created 7 Days Date Received 28 Days Date Received

Name Signature Company Date Time

Samples Received Checklist

Issued By: # of Samples Received Yes No

Samples intact?
Received By:
Samples cured on Receipt?
Issued By:
Samples sizes agree with ASTM C39
Received By:

Remarks: