Report (14) 20( —0561:292-1
171115- skisSa dna 4 tt Office (541)330-9155
Geotechnical Office (503)601-8250
Eugene Office (541)345-0289
Carlson Testing, Inc. Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: 10„,/y7,,,,, " Wel 4(41 Zoi
Address: /7 ei 10 Sw" ?41t '/,i t Jai t•'€ / a CTI Job#: 4,47 SI2.,Z. . e
CTI representative 111 ovIta's (11r ' WaL tx -.21 02. /V 4' was on site this date /19./ to perform
(Inspector Name&Cert.No.)
Special Inspection for ( permit El DFS#(s) A c T. o ) '" o 0 92 / jurisdiction ''/y d' )f era
`--� In some cases more than one box may be checked for a given item.
SCOPE OF INSPECTION Location of proprietary anchors inspected[to include grid
lines,elevations(floors)and drawing details]:
1.Checked in with superintendent or client representative. 'jl S f -b i Wo 1 r R. �t 1(,i 1 Li",4 e t f r 1 E'
-
Name: , ra, r/s I/ c f� ) ss " t; / tp ,J t'/9X Lir `e'lf
Company: A0) 0 P d Akio tdie/14
2.Inspection was"IBC" Continuous Periodic E y' �:r( �'�� t1 t 60,1,1 ,/e
tilt ( ;w. & 't Cd beefi-i. /`r 7
PROPRIETARY ANCHORS ;)fit r�((t Lee, X74 d Vrr► r'el ' 50S of
- Yes No N/A i" lege hi- rim IIf, .
1.Reviewed previous inspection reports? )(
2.Reviewed evaluation report? `
REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was: [ Completed ❑ In progress
3.Verified minimum embedment depth of the x 2.Completed work inspected RIwas ❑ was not
anchors.
in compliance with
4.Verified installation of the anchors.
5.Verified anchor diameter. EidApproved plans and specifications Shop drawings
6.Verified steel grade. RFI 0 Design change ❑ Submittal ❑ N/A
7.Verified hole diameter. x, Document#(s) r° 4 S Dated: —141.0
8.Verified type of drill bit used. }[ 3.Noncompliance item(s)were noted this date,details on
9.Verified hole cleaning method. V following page(s). ❑ Yes IX No ❑ N/A
10.Verified adhesive application.
11.Verified edge distance. 4.Noncompliance item(s)were reinspected this date,details
12.Verified spacing. on following page(s). ❑ Yes No ❑ N/A
13.Verified installation torque. ❑ Conform ❑ Remain in progress
Til
Evaluation report number&date: Report(s)findings were discussed and left with
—�tLS ER.- 2 I ? " r -� — Srx f
of --Name of product being installed __gu 1p ., ,4
Batch Number 341/# r 0/7
Expiration Date -'4-/-
Based on the Code,approval is required from the Building Official before the SPECIAL INSPECTED items noted above can be
covered.Carlson Testing has no authority to direct work of contractors or subcontractors.
Inspector Signature: ,f• '4 'r404
n See additional report page(s). ❑ Distribute attachments. Page 1 of )
PropAnchors Ver.1 2/12/2009
,tlidudnts:
Client recognizes that construction ()User\atstn andfor test deg sop ices piovided ho C H are hechniques
P,inch may reduce the risk of construction detects, deficiencies, or omissions arising during Or alter eon-
Ut.,"Ck}n. Services per dormcd h C I do not con,dit btu ttetrranp or guarantee oldie:, lope. linen with
diligent etunurlictiOn monitoring nod or testing iv 1.1 einistruction de leers.tIOLICieliCiCS,or 01.TliSSiOnS
in the C.C pith-actor's work may exist,. In all cases.Client anktor the.Contractor shall assign the Contractor
the responsibility for the quality and coinpletenesy of. the\yols and •nor adhering,to plans and specified-
CdTs tkork rodtenure to ref-16171 snore dial l no in iov woe excuse;its nbniraLtddr songneunnelon
or supplier fron'r po formunce of ins vo.rk in accordance with the contract documents,
i • pro\lde professional coo'lows to tt Mai,degree of care and skill oblinarily euieleiscd
murder similar clrournytances ho members irrita. prfulesseta rgs icraca eiroi..rntt; edited'tvw
or representation,either expressed or impliodIt is ano dersiood and eureedi dud, o.s mane
C reports are observations based on technited ludgerritunsc anti should not he era unread to he clascre representations of tact. In conditions di Herein.. lrorn vt.hat re indicated in the reports come to
Client's attention alter receipt of the reports, it is reconiniended that.Client,confect C l 1 iirunediau,*, to
authorize further appropriate evaluation.
tdi ‘vorls shall not include supervising or implementtog the means,methods,techniques,
umqueora:rs.or procedures of construction CI..I shall not be resptmsihte roe e,t. eat Mu orrevun ding:Hid con-
dlt inns related to health,safety or welfare.