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Ellis&Associatesia6. Corporates I 7064 Davis Creek Road,Jaeksornllle,FL 32256 P:(904)8800960 F:(904)880-0970
MGroup of Companies Breach Location:
Geotechnical•D rseruoeon Matenala•Environmental•Facilities Brunswick: 134 Neuman Drive,Brunsvdck,GA 31520 P:(912)279-0085 F:(912)279-0086
Daytona: 2706 S.Rid9ewvod Ave.,Sake 2 P:(366)944-9568 F:(386)944-9589
ellisassoc.com South Daytona,FL 32119
Work Order#:
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#:
Subdivision: iJ i t- --1. 1 [' r Reported to: Report#:
Unil or Parcel: Location By: rt Gauge#:
Lot#Block: Contrector.-\ Date Tested: //
Street Address: City: o TL.. -.'r,t 7.t - t,
Method: Course: t 1 L
Material: Specific Requirements: ->'(7
Pass/ Elev/ Base/LR/ Dry Max.Dry % of Max Moist
Fait/ Location Depth Asphalt( Density Density* Density %
Retest /Litt- Thickness -
(_ 1
*So - octor(Project#and/or Work Order#)
I P-T t Meets Specification Requirements F - Test Fails To Meet Specification Requirements R-Retest
To oleted In Field
•--------Standby------------------
pr
Y PProval
Employee Name r -
1 Time Superintendent Printed Name
Start/Stop Travel Standby Job
Superintendent Signature
(Office use)
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