Concrete Placement Record Report No.: Page: ../...

Client: Subcontractor: Foundation/Structure No.:

Project No.: Subcontract P.O. No.: Concrete Supplier:

Name of Project: Grade/Mix Design No.: Reference document Slump max/min .......................... cm Temperature min ........................ C

Theoretical volume ..................... m3

Delivery*Note No.

TruckNo.

BatchTime

Start PourDate/time

Finish PourDate/time

Volume/Accum.Volume m3

Temp. C

MeasuredSlump

No. cylinders made

Cylinder Ref. No.

Remarks

* Attachments, No. of pages

Accepted for Subcontractor Accepted for Company Accepted for Client

Name: Name: Name:

Signature: Signature: Signature:

Date: Date: Date:

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