QR-2000-02

SMALL PROJECTS GROUP

QUALITY CONTROL
MAINTENANCE SERVICE

RECORD NO.
:

SI / PO Number
:

CONCRETE POUR REPORT

SYSTEM NO.
:

Client
:

ITEM
:

PCWBS
:
LOCATION
:
FWBS
:
DRAWING NO.
:

PRE POUR ACTIVITY

FIELD ENG. /
QC INSPECTOR

ITEM
SUPERVISOR
CONTRACTOR
MCL - SPG
MCL - Client

DATE
DATE
DATE
DATE
BLINDING CONCRETE

FORMS/LAYOUT
REINFORCEMENT

DOWEL & ANCHOR BOLTS/BOX

EMBEDDED PLATE

SLEEVE
U/G PIPE

PLUMBING

ELECTRICAL

WATER STOP

ACID PROTECTION
CONSTRUCTION JOINT

EXPANTION JOINT

POUR ACTIVITY
POUR DATE
:

SUPPLIER :

WEATHER
:

AMBIENT TEMPERATURE :

SLUMP
:

CONCRETE TEMPERATURE :

ADDITIVE
:

AIR CONTENT :

TEST SPECIMEN No.

:

QUANTITY SPECIMEN REQ'D :

POUR TERMINATED
:

AMB. TEMP. DURING CURE :

REASON
:

CONCRETE DESIGN MIX

:

ATTACH COPY OF CONCRETE SUPPLIER BATCH TICKETS TO THIS FORM

REMARKS :

CONTRACTOR : --------------

DATE :

COMPANY : MCL -SPG

DATE :

CLIENT : MCL -Client

DATE :
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