1680 Maritime Oak Dr form board elevation certificate C a ,I If
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7064 Davis Creek Road,Jacksonville,R.32256 P:(904)880-0960 F:(904)880-0970
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Geolechnical a construction Materials it Environmental n radices Brunskick: 134 Newman Drive Bakknerii:k,GA 31520 P:(912)279 0085 F:(912)279-0086
Daytona: 2706 S.Ridgewood Ave.,Suite 2 P:(386)W-95,58 F:(386)q 589
ellisassoc.com South Daytona,FL 32119
ge ort of In-Place Density (Asphalt or Soil) Tests or Coring for Thickness (Circle One)
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Contractor: je"" Method: Work Order#: 7/ "1
Reported To: T� Project#: 0 7
L,ocation: =n Report#:
Material: Come:
Dow Tested: —7-1, 17 Spec.Requirements: Gauge#:
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Location IayL� Bas Dry Max. % of Moist
,6epth,/) Asphalt Density Dry Max
Retest Thickness Densit Densi %
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To Be Completed In Field
Standby Approval
Employee Name Superintendent printed Name
Time
Start/Stop Travel Standby Job
Superintendent Signature
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FORM BOARD ELEVATION CERTIFICAii
Duval County I Clay County
[Erl-.ft copy on site F-1 No box
Lot and Subdivision: 7-7- 4,r4-w7-/c os*cy c.
DATE:
PERMIT
NUMBER:
ADDRESS: 16so
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: /j�6o
ACTUAL ELEVATION OF FORM BOARD OR
GRADESTAKE:
SURVEY COMPANY
NAME: Bartram Trail Surveying, Inc.
1501 CR 315, Suite 106
Green Cove Springs, FL 32043
SIGNATURE OF SURVEYOR: (Party Chief)
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