04-6326 (3)MTG`..
Corporate:
2992 E. La Palma Ave., Ste
Anaheim, CA 92806
Tel: 714.632.2999
Fax: 714.632.2974
San Diego/Imperial County:
7313 Carroll Road, Suite G
San Diego, CA 92121
Tel: 858.537.3999
Fax: 858.537.3990
Inland Empire'
14320 Elsworth Street, Ste. C101
Moreno Valley, CA 92553
Tel: 951.653.4999
Fax: 951.653.4666
FIELD REPORT
TYPE OF WORK eINSPECTOR
❑ TECHNICIAN
AVAILABLE: SOIL REPORT (Y) (N) SPECS qD(N)
APPROVED PLANS(d�J(N) APPROVED SHOP DRAWING (Y) (N)
ARCHITECT
FOR WEEK ENDING
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PROJECT. NO.
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ENGINEER
REPORT NO. PG OF
CONTRACTOR
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PLAN FILE NO.
PERMIT NO.
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SUBCONTRACTOR
PROJECT NAME
INSPECTION ADDRESS
ADDRESS OF PROJECT
REPORTING REQUIREMENTS: ICBO FIELD INSPECTION MANUAUMTGL SOIL MANUAL- REVIEW PREVIOUS REPORTS AND LISTS
IF THERE IS NON -CONFORMING WORK AT THE END OFTHE 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 COPY WITH YOUR WEEK'S REPORTS.
MATERIALS USED BY CONTRACTOR (INCLUDE RESEARCH REPORT NO. OR MATERIAL TEST REPORTS):
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CONTRACTORS EQUIPMENT/ MANP�OWE USED:
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AREA, GRID LINES, PIECES OBSERVt—
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STRUCTURAL NOTES, DETAIL. OR RFIS USED:
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REMARKS. INCLUDING MEETINGS:
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REWORK AS PERCENT OF ALL WORK
TODAY: PERCENT PROJECT COMPI ETION•
WEATHER: �L�
TEMPERATURE:
SAMPLES TAKEN: !-
TESTS REQUIRED: _ may_
SITE TIME START: I O CJ = SITE TIME FINISH: C_- C-`_
LUNCH PERIOD:
TRAVEL TIME:
VERIFIED BY:
I DO CERTIFY THAT I HAVE PERSONALLY OBSERVED ALL OF THE WORK LISTED ABOVE AND THAT THIS WORK COMPLIES WITH THE SOIL INVESTIGATION RECOMMENDATIONS,
AND / OR THE APPROVED PLANS, SPECIFICATIONS AND APPLICABLE SECTION OF THE BUILDING CODE, UNLESS OTHERWISE NOTED IN THE DEFICIENCY REPORT
0
Signature Date of Report ICBO Certification Number
Print Name
City / County Certification Number
Rev: 7/97