04-6326 (2)MTG L
Corporate: F
2992 E. La Palma Ave., Ste
Anaheim, CA 92806 -
Te 1: 714.632.2999
Fax: 714.632.2974
San Diego/imperial County:
A 7313 Carroll Road, Suite G
San Diego, CA 92121
Te 1: 858.537.3999
Fax: 858.537.3990
Inland Emp(__.'
14320 Elsworth Street, Ste. C101
Moreno Valley, CA 92553
Tel: 951.653.4999
Fax: 951.653.4666
FIELD REPORT
TYPE OF WORK PNSPECTOR OTECHNICIAN
1A
AVAILABLE: SOIL REPORT (Y) (N) SPECS (Y)(N)
APPROVED PLANS APPROVED SHOP DRAWING (Y) (N)
AR3�Z 41
FOR WEEK ENDING
TP ROJECT. NO.
ENGINEER
. e
REPORT NO. PG OF
CONTRACTOR
PLAN FILE NO.
PERMIT NO.
SUB-CONTRACTO
ROJECT IN ME
INSPECTION ADDRESS
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ADDRESS OF PROJECT
REPORTING REQUIREMENfS: ICBO FIELD INSPECTION MAN . UAUMTGL SOIL MANUAL - REVIEW PREVIOUS REPORTS AND LISTS
IF THERE IS NON -CONFORMING WORK AT THE END OF THE WORK DAY, OR MISSING MTRS, AND RFIS, ETC., FILL OUT AND ATTACH A DEFICIENCY REPORT
WHEN A DEFICIENCY, YOURS OR A PREVIOUS INSPECTOR'S, IS CORRECTED, SO NOTE ON THE ORIGINAL DEFICIENCY REPORT AND
SUBMIT A COPY WITH YOUR WEEK'S REPORTS.
MATERIALS USED BY CONTRACTOR (INCLUDE RESEARCH REPORT NO. OR MATERIAL TEST REPORTS):
CONTRACTORS EQUIPMENT/ MANPOWER USED:
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AREA, GRID LINES, PIECES OBSERVED:
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STRU�TURAL NOTES. DETAIL. OR RFIS USED:
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REMARKS, INCLUDING MEETINGS.
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REW RK AS PERCENT 01ALL WORWTnnCy*
HUM P&JECT COMPLETION6
WEATHER:A,,-t� aolz/_
TEMPERATURE: L�P,� 6v� 7
SAMPLES TAKEN:
TESTS REQUIRED:
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SITE TIME START:. � C., I -� c-,
SITE TIME FINISH:
LUN CH PERIOD: —1 en TRAVEL TIME: VERIFIED BY: �A
.1 DO CERTIFY THAT I HAVE PERSONALLY OBSERVED ALL OF THE WORK LISTED ABOVE AND THAT THIS WORK COMPLIES WITH THE SOIL INVEST14TION RECOMMENDATIONS,
AND / OR THE APPROVED PLANS, SPECIFICATIONS. AND APPLICABLE SECTION OF THE BUILDING CODE, UNLESS OTHERWISE NOTED IN THE DEFICIENCY REPORT
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Signature Date of Aeport ICBO Certification Number
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Print Name
City / County Certification Number