355 W 3RD ST RES18-0385 FOAM BOARD Jacksonville
7064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F:(904)880-0970
Brunswick
134 Newman Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
ecslimited.com
Work Order#:
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#:
Subdivision: {moi t Reported to: — Report#:
Unit or Parcel: Location By: z: i Gauge#:
Lot#Block: Contractor: = 4 =t Date Tested: <
Street Address: ! City: '/
Method: r Course: l
Material: �' Specific Requirements:
Pass/ Elev/ Base/LR/ Dry Max.D % of Max Moist
Fail/ Location ` Depth Asphalt/ Density Density* Density %
Retest /Lift Thickness
*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 Job
Superintendent Signature
---------------------------------
(Ofce use)
ECS-10(rev.01/18) white copy-office use yellow copy-personal use pink and goldenrod-client use page of
FORM BOARD ELEVATION CERTIFICATE
Date - Permit Number: A)
Address: 35SylFe.>f 3,d sl.
All American Surveyors Work Order # 16' 988,5—
Required
9885Required Slab Elevation on City Approved Site Plan:
8. L<0
Actual Elevation of Form Board or Grade Stake:
Survey Company:
ALL AMERICAN SURVEYORS OF FLORIDA INC.
3751 San Jose Place, Suite 15
Jacksonville FL 32257 Work Phone: 904-279-0088
Signature of Surveyor: (PartyChief)