Report 0 e -or i95
' A.
FROM : FAX NO. :5036207074 ,tn. 16 2006 02:53PM P4
Main Office Salem Office Send Office
P.O. Box 23814 4060 Hudson Ave., NE . P.O. Box 7918 • ligard, Oregon 97281 Salem, OR 97301 Bend, OR 97708
�n �-+ • �y Inc. hone (503) 884 -3460 Phone (503) 589 1252 Phone (541) 330.9155
l son �� w��j114 ' J� Fax (503) 684 -0954 Fax (503) 589 -139 Fax (541) 330-8163
Special Inspection Page of
'-1 DAILY HELD REPORT
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Project: �t .. 1 Date: f (r? 3 c�.t L
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Job Address: 02 , l ,,) a c, /k Job No. ) (1 '7 ? ',.._ (- 3C
Permit No.: P T _ Type of Jnspection; (P 'WS)
Field [Q.Fab Shop Weather:
Inspection Notes (include location, testing data, substitutions /deviations, materials and methods of construction, non- conforming items,
acceptance criteria, corrected non - conforming items, etc.):
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* ** CHECK ONE BOX ONLY * ** YES NO
I. This is a preliminary inspection only. — OR — U
2. The work inspected conforms to acceptance criteria listed above. If "No," the portions of the work that are
non - conforming items are clearly stated above and will be added to the NCL. Remaining portions of the work, which [''
are not preliminary in nature, are to be considered as conforming.
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Inspector Certification No.: ) ( / Use of the information contained in this report constitutes acceptance of all terms on the reverse of this form and Carlson Testing, lnc,'s General Conditions.
Ti , funnntinn cnnta i t heroin is not to ho OF, '.'ccd, except in full, without pi itr out.hnrintion limn this, officc,