Elastizell LDIC Pouring Audit Report

• Document No.

• Project Number

• Project Name

• Conducted on

  Date

• Superintendent Name

• Location
  Address

PROJECT INFORMATION & CONDITIONS:

• Mix Design:

  160-250 PSI (Nail Base)

  250-350 PSI (Glue Down)

  500 PSI

  600 PSI

  800 PSI

• Temp (F)

• Sky Conditions:

  Select Sunny Partly Cloudy Mostly Cloudy Scattered Showers Rainy Snow Storm

  • Sunny
  • Partly Cloudy
  • Mostly Cloudy
  • Scattered Showers
  • Rainy
  • Snow Storm

JLE CONCENTRATE DILUTION RATIO

• What did you use to generate foam?

  Foam Trailer

  Tankless Foamer (Hart Pump)

• Is the JLE dilution ration 40-1?

  Yes

  No

• What was the dilution ratio?

  36-1

  32-1

  Other

• What was the dilution ratio?

CALIBRATION:

• Number of seconds to fill 55 GAL. drum with foam:

• Was the water meter calibrated?

  Yes

  No

BATCH:

• LBS. of cement per batch:

• GAL. of water per batch:

• Seconds of foam per batch

• Was the water heater used?

  YES

  NO

• At what temperature was the output set (F)?

SAMPLES / BUCKET WEIGHTS

• We're cylinder samples taken? <br>(White Styrofoam Boxes)

  Yes

  No

  N/A

• What time(s)? If more than one sample was taken, select multiple times.

  Select 7:00AM 7:30AM 8:00AM 8:30AM 9:00AM 9:30AM 10:00AM 10:30AM 11:00AM 11:30AM 12:00PM 12:30PM 1:00PM 1:30PM 2:00PM 2:30PM 3:00PM 3:30PM 4:00PM 4:30PM 5:00PM 5:30PM 6:00PM 6:30PM 7:00PM

  • 7:00AM
  • 7:30AM
  • 8:00AM
  • 8:30AM
  • 9:00AM
  • 9:30AM
  • 10:00AM
  • 10:30AM
  • 11:00AM
  • 11:30AM
  • 12:00PM
  • 12:30PM
  • 1:00PM
  • 1:30PM
  • 2:00PM
  • 2:30PM
  • 3:00PM
  • 3:30PM
  • 4:00PM
  • 4:30PM
  • 5:00PM
  • 5:30PM
  • 6:00PM
  • 6:30PM
  • 7:00PM

• Box ID # (Job number + letter) (1234A)

• Were bucket weights taken?

  Yes

  No

  N/A

• Bucket Weight(s)

#

• What time?

  Date

• Net Bucket Weight (lbs):

APPROVAL SIGNATURE

• Superintendent Signature

  Sign