Concrete Air, and Quantity I.D. Number (1): Inspector No. Date Sequence No County (2): (3): (4): (5): Section: Conc. Prod. No Concrete Code AEA Route: (6): (7): (8): Prod. Name Prod. Location District: (9): (10): Contract No.: Cement Prod Cement Code Admixture Job No.: (11): (12): (13): Responsible Loc Lab Lab Name Project: (14): (15): (16): Type Test City: (17): Contract Job Design Date Water Conc Air Air Slump Type AEA Qnty Load SFX Number Number Number Cast Location Gal Temp Temp % inches Const oz/cwt oz/cwt cuyd Series Result No. (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) (29) (30) (31) (32) (33) (34) (35) Sequence No. I.D. Number Contract Job Design Date Location Water Conc Air Temp Air Slump Type AEA Admix Qnty Load SFX Number Number Number Cast Gal Temp % inches Const oz/cwt oz/cwt cuyd Series Result No. Reported By Remarks Copies To (36): (37): (40): (Printed Name and signature are required) Tester Agency C (38): (39): (41): (Printed Name and signature are required) MISTIC INPUT /FOR DTY03654 BMPR MI654 (Rev. 11/01/12) Date Entered (42): (Formerly MI 654) Initials (43): Printed
Concrete Air, and Quantity I.D. Number (1): Inspector No. (3): Date (4): Sequence No (5): County (2): Section: Conc. Prod. No (6): Concrete Code (7): AEA (8): Route: Prod. Name (9): Prod. Location (10): District: Contract No.: Cement Prod (11): Cement Code (12): Admixture (13): Job No.: Responsible Loc (14): Lab (15): Lab Name (16): Project: Type Test (17): City: SFX (18) Contract Number (19) Job Number (20) Design Number (21) Date Cast (22) Location (23) Water Gal (24) Conc Temp (25) Air Temp (26) Air % (27) Slump inches (28) Type Const (29) AEA oz/cwt (30) oz/cwt (31) Qnty cuyd (32) Series (33) Result (34) Load No. (35) Sequence No. I.D. Number SFX Contract Number Job Number Design Number Date Cast Location Water Gal Conc Temp Air Temp Air % Slump inches Type Const AEA oz/cwt Admix oz/cwt Qnty cuyd Series Result Load No. Reported By (36): Remarks (37): Copies To (40): (Printed Name and signature are required) Tester (38): Agency (39): C (41): (Printed Name and signature are required) MISTIC INPUT /FOR DTY03654 BMPR MI654 (Rev. 11/01/12) (Formerly MI 654) Date Entered (42): Initials (43): Printed
BMPR%20MI654.docx