Concrete Pour Form - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Project Location
  Address
• Location of Pour
  Address

• Time

  Date

• Temperature

Mix Design

• Add photo or screenshot of Mix Design

  Media

• Add photo or screenshot of engineering spec

  Media

• Max Air Content %

• Minimum Air Content %

• Max Slump (inches)

• Minimum Slump (inches)

• Max temperature

• Pour Location
  Address

• Total Yards Poured

• Batch Time

• Pour End Time

• Testing Frequency?

• Number of Trucks

• Concrete Truck Ticket

  Media

• Number of Cylinders Made

• Tremie, Drop or Elephant Trunk?

  Tremie

  Drop

  Elephant Trunk

• Explain why tremie or elephant’s trunk not used

• Pump Truck?

  Yes.

  No.

• Concrete Vibrated?

  Yes

  No

• Dry or Watered Hole?

  Dry

  Watered

• Water Depth?

• Quantity of Water Added

• Add Tests

Test

• Test Number

• Air Entrainment

• Add photo of Air Gauge with test result

  Media

• Slump (inches)

• Add photo of Slump measurement

  Media

• Temperature

• Add photo of Temperature Gauge Measurement

  Media

• Comments/Problems

• Inspector Signature

  Sign

• Customer Representative Signature

  Sign