Report (160) Professional Service Industries,Inc.
6032 N Cutter Circle,Suite 480
• Portland,OR 97217
Intertek prffli CCB No. 176269
Special Inspection Daily Field Report Phone:(503)289-1778
Fax:(503)289-1918
CLIENT: WORK ORDER NO.:
PROJECT: -136G sw Lewd onct Lcsi DATE:
General Contractor:
Permits: 7 I Weather: •r-e;
Q.QC — G3L - Type of Inspection Performed
CI Reinforced Concrete 0 Structural Masonry 0 High Strength Bolting 0 Fireproofing CyNew Inspection 0 Re-Inspection
0 Reinforcing Steel 0 Soils 0 Welding abther Standby Time:
Field Observations&Comments
L.. Special Inspection ziContinuous !. .1 Periodic
Location(s)/Item(s):
Referenced Details/Drawings:
- - ,
Remarks: .
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To the best of Intertek-PSI's knowledge,the work inspected to the approved construction documents are:
a Conforming 0 Non-Conforming
Inspector: `‘.. Inspector Cert No.:
Jobsite Representative:
These test results apply only to the specific locations and materials noted and may not represent any other locations or elevations.This report may not be reproduced,except in Ml,without
written permission by Intertek-PSI.
Rev.2017 0109