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Ellis&Associates 7064 Davis Creek Road,Jacksonville,R.32256 P:(904)880-0960 F:(904)B80-0970
L=mjBranch Location:
Geotechnical a Materials Testing • Environmental • CEI services Brurewick: 227 Rose Drive,Bmnsv ick,GA 315M P:(912)2710085 F:(912)279-0086
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Work Order#:
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#:
Subdivision: 411( wr : . , r Reported to: Report#:
Unit or Parcel: - Location By:
.. ;.1 — Gauge#: � -
Lot#/Block: Contractor:
Date Tested: L
Street Address: y '{ l 'v ( "' City:
Method: Course:
Material: Specific Requirements: 7' �-
Pass/ Elev/ Base1LR/
FaiV Location Depth Asphalt/ Density Density Density %
*Source of Proctor(Project#and/or Work Order#)
`P-Test Meets Specification Requirements F-Test Fails To Meet Specification Requirements R-Retest
To Be Completed In Field ,____________________ _
Standby Approval
Employee Name
Time Superintendent Printed Name
Start Stop Travel Standby lob
Superintendent Signature
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(Osice use)
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FORM BOARD ELEVATIONERTIFICATE
Duval County / Clay County
EDLeft copy on site No box
Lot and Subdivision:-
DATE:
PERMIT - -- - — ------ - -
NUMBER: I s F K
ADDRESS:
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN:
ACTUAL ELEVATION OF FORM BOARD OR
GRADE STAKE: i ti 8
SURVEY COMPANY --- — —
NAME: Bartram Trail Surveying, Inc.
1501 CR 315,Suite-108_
Green Cove Springs, FL 32043
SIGNATURE OF SURVEYOR: (Party Chief)