CONCRETE CONSTRUCTION REPORT

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CONCRETE CONSTRUCTION REPORT


CONTRACT NO.

REGION

HIGHWAY NO

DATE OF PLACEMENT


Y R M O DAY



AM

CYLINDERS MADE AT PM

















DAYS

TEST AT HRS

STRUCTURE NAME

SITE NO.




TYPE OF TEST

1


COMPRESSIVE CYLINDERS 5


COMPRESSIVE CUBES

2


FLEXURAL BEAM

6


AIR VOID SYSTEM

3


AUTOGENOUS CYLINDERS 7


RAPID CHLORIDE

4


TENSILE CYLINDERS PERMEABILITY









LOT NO.

TEST NO.

END RESULT SPEC.

TEST LOCATION (STATION NO.)











YES



NO











NAME AND LOCATION OF

CONTRACTOR PLACING CONCRETE




NAME AND LOCATION OF READY MIX CONCRETE SUPPLIER


SUPPLIER CODE






CONCRETE MIX DESIGN


NUMBER

YEAR

CLASS

MOD

TYPE OF MODIFICATION


S


SLAG SF


SILICA FUME

FA


FLY ASH

LM
-

LATEX

NAME OF SUPERPLASTISIZER/RETARDER




OPERATIONS



MATERIALS MODIFICATION













COARSE AGG (1)


BATCHING


MIXING


PLACING


FINISHING


CURING



COARSE AGG (2)


1.WEIGHT

2.VOLUME

3.CEMENT ADDED
ON SITE

4.OTHER


1. REA
DY

2. CENTRAL

3. SITE

4. MOBILE

5. OTHER


1.BUCKET

2.PUMP

3.BELTS

4.TREMIE

5.CHUTE

6.OTHER


1.HAND

2.MACHINE

3.SLIPFORM

4.OTHER


1.CURING COMPOUND

2.WET BURLAP

3.VAPOUR BARRIER

4.INSULATED

5.HOUSING

6.OTHER



FINE AGG



WATER


X


0


NOT MODIFIED

1
-

HEATED

2
-

COOLED




TYPE OF WORK


LOCATION
(IF TYPE OF WORK IS A BRIDGE)








01 BRIDGE


05 CULVERT


08 MEDIAN 13 PRECAST

17 SIDEWALK

02 BASE/PAVEMENT

06 CURB &


09 GROUTING



14 REPAIR


18 TRESTLE

03 CATCH BASIN

GUTTER


10 DAM


15 RETAINING

19 TUNNEL


& MANHOLE

07 BARRIER


11 DOC K WALL


20 OTHER

04 CHANNEL LINING


WALL


12 BUILDING


16 SEWER


01 ABUTMENT



06 FOOTING


11 EXP. JOINT

02 APPROACH SLAB

07 BARRIER WALL

12 DIAPHRAGM

03 BEAM


08 SIDEWALK


13 BALLAST WALL

04 COLUMN/PIER

09 WINGWALL


14 OTHER

05 DECK


10 DECK OVERLAY



FIELD TESTS ON CONCRET
E REPRESENTED BY CYLINDERS

(TO BE COMPLETED BY CONTRACTOR’S TESTER)


LOCATION OF CONCRETE REPRESENTED BY CYLINDERS


TICKET OR TRUCK NO


SLUMP (mm)


AIR CONTENT (%)


CONC. TEMP (C°)






WEATHER DESCRIPTION

AIR TEMP (C°)














COMPOSITE SAMPLE
TEST RESULTS






SLUMP (mm)


AIR CONTENT (%)


TEMP.

















INITIAL CYLINDER CURING TEMPERATURE

REMARKS




MINIMUM °C



MAXIMUM °C








TESTING
COMPANY’S
NAME




















TESTER’S CERTIFICATION


MTO INSPECTOR’S LAST NAME, INITIALS
























TESTER’S LAST
NAME, INITIALS




















ACI


CSA












































TESTER’S SIGNATURE


MTO INSPECTOR’S SIGNATURE


LABORATORY U
SE ONLY


NAME AND LOCATION OF
LABORATORY

DATE RECEIVED (Y/M/D)

AGE AT TEST

DATE TESTED (Y/M/D)



TYPE OF MOLD

C CARDBOARD P PLASTIC S STEEL T TIN

















CYLINDER A OR BEAM

CYLINDER B


LAB. CYLINDER NO.


CYLINDER CONDITION REMARKS


LAB. CYLIND
ER NO.


CYLINDER CONDITION REMARKS











CONDITION



WEIGHT


FORM OF BREAK


STRENGTH (MPa)


CONDITION


WEIGHT


FORM OF BREAK

STRENGTH (MPa)




















PH
-
CC
-
322 July 14, 2004

DISTRIBUTION: REG. Q.A.

HEAD CONC. SECTION CONT. ADMIN.