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MI EllisUssociatesw- 064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F:(904)880-0970
Geotechnical ■ Materials Testing ■ Environmental ■ CEI Services Branch Location
Integrated Engineering Services Brunswick: 227 Rose Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
ellisassoc.com
Report of In-Place Density (Asphalt,or Soil) Tests or Coring for Thickness (Circle One)
Project: i t_£E-r
Contractor: l 1 Method: — Work Order#: .'c
Reported To: Location by: ! t _7Project#:
Location:
t- -_I e �; ,, E +t Report#:
Material: Courser
.. �. i .. 5-1 Gauge#: ,
Date Tested: Spec.Requirements: � �'
r Pass/ ,% Elev/._.. Base/LR/ Max. % of
Dry Moist
Falb Location Depth/ Asphalt Dry Max
Retest Lift- Thickness Density Density* Density %
LI
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*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 '
Superintendent Printed Name
Time '
Start/Stop Travel Standby Job
Superintendent Signature
------------------------------
(Office use)
EA-03(rev.01/14) white copy-office use yellow copy-personal use pink-client use Page_of
MICorporate
EllisUssociatesi.. 7064 Davis Creek Road,Jacksonville, FL 32256 P:(904)880-0960 F:(904)880-0970
Geotechnical ■ Materials Testing ■ Environmental ■ CEI Services Branch Location
Integrated Engineering Services Brunswick: 227 Rose Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
ellisassoc.com
Report of In-Place Density (Asphalt or Soil) Vests or Coring for Thickness (Circle One)
Project: `,t.t: _7- C°A
Method: ' t
Contractor: �[ k < '��-'� Work Order#: ,��
Reported To: Location by: r` 7
Project#:
Location:—T " }
Material: ` + � Course: t + Report#:
Date Tested: Spec.Requirements = Gauge#: 1
Pass/ Elev/ Base/LR/ Max. % of
Fait/ Location Depth/ Asphalt Dry Dry Max Moist
Retest Lift Thickness Density Density* Density %
tel
``1 � •_� try !`iy(' �� �
J _
j a
}} r
f >
*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 L.
Superintendent Printed Name
Time
Start/Stop Travel Standby Job
Superintendent Signature
_ � r
L--------------------------------'
(Office use)
EA-03(rev.01/14) white copy-office use yellow copy-personal use pink-client use Page-of