Michigan Department of Transportation

0590 (04/19)

FIELD AND LAB TEST REPORT To be completed by the QA inspector and included in the final project documentation.

REPORT #

GENERAL INFORMATION INSPECTION AGENCY INSPECTOR DATE

FABRICATOR / LOCATION CONTROL SECTION

JOB DESCRIPTION SIZE AND ELEMENT TYPE JOB NUMBER

STRENGTH REQUIRED

SERIES STRIPPING STRENGTH (PSI) TRANSFER STRENGTH (PSI) 28-DAY STRENGTH (PSI)

FIELD TEST DATA

TIME AIR (%) SLUMP (IN) CONCRETE (°F) AIR (°F)

QC TESTER:

QA TESTER:

STRIPPING/TRANSFER STRENGTH RESULTS

CYLINDER MARKS TEST DATE TEST AGE CYL 1 (PSI) CYL 2 (PSI) CYL 3 (PSI) APPROVED INSPECTOR

28 DAY STRENGTH RESULTS

CYLINDER MARKS TEST DATE TEST AGE CYL 1 (PSI) CYL 2 (PSI) CYL 3 (PSI) AVG (PSI) APPROVED INSPECTOR

SHIPPING INFORMATION

ELEMENT MARK DATE SHIPPED INSPECTOR APPROVED COMMENTS

ELEMENT MARKS

SUBLOT 1 CYLINDER MARKS

SUBLOT 2 CYLINDER MARKS

SUBLOT 3 CYLINDER MARKS

COMMENTS

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