1620 Maritime Oak Dr slab inspection & density test resultsr`
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0 Ellis&Associates co'pomte
7064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F: 904)880-0970
SGroup of Companies Branch Location:
Geuteodnieal•tunstrucWn Malanals•EnNmnn a tal a Feoli4es Brunswick: 134 Newman Drive,Brunswick,GA 315M P:(912)279-0085 F:(912)279-0096
Daytona: 27065.Riidgees ad Ave.,Suds 2 P:(386)944-9588 F:(386)944-9589 -
ellisassoc.com i$ouo Daytona,FL 32119
Work Order#: ' 2'41
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#: n
Subdivision: :kit " k : r b c I Reported in: Report It:
Unit or Parcel Location By: Gauge#: )
Lo[#/Block: 2 Contractor. I
Date Tested: 11 - -tl
Street Address: 160= 1-1 City: u
Method: Course: G. . .
Material: - - - Specific Requirements:
Pass/ Elev/ Base/LR/ Dry Max.Dry % of Max Moist
FaiU Location Depth Asphatf * -
Retest /Lift Thickness Density DensityDensity %
Cy ,rte t Tz' V
*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
_ _
Standby Approval
Employee Name �f -
Time Superintendent Printed Name
Stan/Stop Travel Standby lob
Superintendent Signature
(Office urs)
EA-10oev.04/16) white copy-fceuse yellow copy-Personal use pinkad,1k.rod-clienrure Pelle_f_
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