06149 (SPIN)[AND.-HRK
INSPECTIONSPECIAL REPORT
REGISTERED INSPECTOR'S DAILY REPORT
Geo -Engineers and Geologists
BUILDING PERMIT NUMBER
PLAN FILE NUMBER
COVERING WORK PERFORMED
WHICH REQUIRED APPROVAL BY
THE SPECIAL INSPECTOR OF
w REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ GLUE. LAM. FABRICATION
❑ PRE -STRESSED CONCRETE ❑ REINFORCED GYPSUM ❑)POST -TENSIONED CONC.
❑ REINFORCED MASONRY ❑ PILE DRIVING N OTHER
JOB ADDRESS
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PROJECT NUMBER
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DATE
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OWNER OR PROJECT NAME -p
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ARCHITECT
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CONSTR. MAT'L. (TYPE GRADE, ETC.)
DESIGN STRENGTH
SOURCE OR MFGR.
ENGINEER
DESCRIBE MAT'L. (MIX DESIGN, RE -BAR GRADE & MFGR., WELDING, ETC.)
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GENERAL CONTRACTOR
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CONTR. DOING REPORTED WORK
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LAB. RECEIVING & TESTING CONSTR., MAT'L. SAMPLES
ITEM
NO.
LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
INCLUDES INFORMATION ABOUT. AMOUNT OF MATERIAL PLACED OR WORK PERFORMED; NUMBER, TYPE & IDENT. NO'S OF TEST SAMPLES
TAKEN; STRUCT. CONNECTIONS, WELDS MADE, H.T. BOLTS TORQUED, CHECKED, ETC.
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❑ CONFORMS to DSA Documents
❑ DOES NOT CONFORM to DSA Documents
Q] PROGRESS REPORT ONLY J\ �CC)VtA P C>
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Form No. 2180 - Pioneer Printing (760) 353-5401
SIGNATURE OF REGISTERED INSPECTOR
NAME OF REGISTERED REGISTRATION NUMBER
INSPECYTOR (PRINT)
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DATE LEA NUMBER