Report 7409 SW Tech Center Dr.Ste. 145
Tigard,OR.97223
SPHALT Ph:503-443-3799 Fax: 503-620-2748
4111=ONcTE DAILY FIELD REPORT FOR PROPRIETARY ANCHORS
OILS
TESTING, INC '1'.77,77:101q
I'. ^7"' ""'1
503.443.3799 Date: ' C�1 Permit#:
Job Name: 7.) _
Continuous Periodic _
Address •c! ,
(1,
ONLY 1 SIZE PER REPORT State
City i2 C v:,./
INSPECTOR/CERT ACS Job #
Anchor Embedded in: Concrete, Masonry, Brick
Other: IS THIS A REINSPECTION?: Yes No
Compressive Strength: APPROVED PLANS AVAILABLE Yes No
HOLE DETAIL/CONDITION WORK ACCEPTABLE PER
APPROVED PLANS: Yes No
ANCHOR HOLE ',' HOLE 'I Z.--
\\SIZE: DIA. IS INSTALLATION PER
��j DEPTH:
MANUFACTURER'S RECOMMENDATIONLI Yes No
Holes cleaned properly?: Yes No
Hole depth per plans?: Yes No LOCATION OF ANCHORS
GRIDLINES
INSTALLATION
ESR-1385 KWIK BOLT 3 MASONRY ANCHORS
ESR-1056 TITEN HD MASONRYS CREW ANCHORS, GRIDLINES
ESR-2713 TITEN HD CONCRETE SCREW ANCHORS
ESR-2583 POWERS PE 1000+CONCRETE GRIDLINES
ESR-1967 HILTI-HIT HY 150 MAX
ESR-3013 HILTI-HIT HY 150 MAX SD
ESR-1772 SIMPSON SET 22 SET PAC&SET EZ BRICK/MASONRY
ESR 2508 SET-XP EPDXY IS THERE AN RFI? Yes No
ESR-1917 TZ CARBON&STAINLESS IN CONCRETE
ESR-2322 HILTI-HIT-RE 500-SD _ RFI ATTACHED? Yes No
ESR 2251 ITW REDHEAD TRUBOLT INSPECTION DETAILS:
OTHER:
ANCHOR TYPE
ALLTHREAD, REBAR, WEDGE ANCHOR,
TITEN SCREW, THREADED SCREW DROP IN ANCHOR
OTHER:
EPDXY
N/A, Simpson Set 22, Simpson Set 56, Simpson Set Pac,
Set Pac EZ, Hilti Hit RE 500 SD, Set-XP, Hilti Hit HY 150
Other:
Exp.Date:
Foreman notified of Yes No NA
nonconformance items?
Foremans Name:
ACS inspectors have no authority to direct, advise or in any
Inspector: capacity supervise work. Inspectors only function is to
observe the work being performed and report it accurately in
this report.