04-6336Corporate:
2992 E. La Palma Ave., Ste
Anaheim, CA 92806
Tel: 714.632.2999
Fax: 714.632.2974
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anlego/ rope, a County.
7313 Carroll Road, Suite G
San Diego, CA 92121
Tel: 858.537.3999
Fax: 858.537.3990
Inland Empiric:
14320 Elsworth Street, Ste. C101
Moreno Valley, CA 92553
Tel: 951.653.4999
Fax: 951.653.4666
FIELD REPORT
TYPE OF WORK INSPECTOR 0 TECHNICIAN
AVAILABLE: SOIL REPORT^(N) SPECS (N)
APPROVED PLANS k!) (N) APPROVED SHOP DRAWING K (N)
ARCHITECT
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ENGINEER
ev S S,
FOR WEEK ENDING PROJECT. N0.
REPORT NO. PG OF
CONT CTOR
PLAN FILE NO.
PERMIT N0.
SUB -CONTRACTOR t
PROJECT NAME
G -
INSPECTION ADDRESS
ADDRESS OF PROJECT
REPORTING REQUIREMENTS: 160 FIELD INSPECTION MANUAUMTGL SOIL MANUAL - REVIEW PREVIOUS REPORTS AND LISTS
IFTHERE 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):
CONTRACTORS EQUIPMENT / MANPOWER USED:
AREA, GRID LINES, PIECES OBSERVED:
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fi � �. 7_6 /,'� s/'%� �l�a/�
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STRUCTURAL NOTES. DETAIL, OR RFIS USED:
REMARKS, INCLUDING MEET7NGS:
REWORK AS PERCENT OF ALL WORK TODAY
P RCENT PROJECT COMPI ETIO Io
WEATHER:
TEMPERATURE:
SAMPLES TAKEN:
TESTS REQUIRED:
SITE TIME START: /k10 c� SITE TIME FINISH:
LUNCH PERIOD: TRAVEL TIME:
VERIFIED BY:
I UU CERTIFY T AT HAVE PERSONALLY OBSERVED ALL OF THE WORK LISTED ABOVE AND THAT THIS WORK COMPLIES WITH PTHE SOIL lI ESTIGATION RECOMMENDATIONS,
AND / OR T OVED PLANS, SPEC NS AND APPLICABLE SECTION OF THE BUILDING CODE, UNLESS OTHERWISE NOTED IN THE DEFICIENCY REPORT
/Dl e l a,0 S-
ignature Date of Report P ICBO Certification Number
Print Name City / County Certification Number
Rev: 7197