371 8th st I
Corporate
Ellis&Associates NIC. 7064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F:(904)880-0970
Branch Location:
Geotechnical ■ Materials Testing ■ Environmental ■ CEI Services Brunswick: 227 Rose Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
Integrated Engineering Services
ellisassoc.com
Work Order#: /
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#: 3_.S 21 e v, t
Subdivision: ��/ �► _S' }' Reported to: Report#:
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Unit or Parcel: Location By: Gauge#:
Lot#Block: r Contractor: i R 1 L < 2 rT Date Tested: �I 2 f7 /C
Street Address: Z7 AA_ S � City:
Method: Course: I::-, L l
Material: Specific Requirements:
Pass/ Eley/ Base/LR/ Dry Max.Dry % of Max Moist
Fail/ Location Depth Asphalt/
RetestDensity Density Density %
,.V/-Q,� �;,; ?-,GT lift-- Thickness
.x
*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 J615..
Superintendent Signature
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(Office use)
EA-10(rev.11/14) white copy-office use yellow copy-personal use pink and goldenrod-client use Page—of