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SPECIAL INSPECTION DAILY REPORT

Project Name:
Project Location:
SCO ID #:
Date of Inspection:

Inspector: SI Company Project No.

Inspector's Company:

Inspection Type(s):

Circle One: Continuous Periodic

Time Inspection Begun: Time Inspection Completed:

Area Inspected:

Describe Inspections Made:

List Tests Performed: 1

2
3
Discrepancy Notice #
Discrepancies Observed: (if applicable)
1 DN #
2 DN #
3 DN #
4 DN #

Corrections completed while on site:

1
2
3
4

Comments:

To the best of my knowledge, the work inspected was in accordance with the contract documents,
except as noted above.

Inspector's Signature: Date:

(A copy of this report is to remain at job-site. Use additional sheets if necessary.)

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Contractor's Initials:

(A copy of this report is to remain at job-site. Use additional sheets if necessary.)

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Date:
Project:
Contractor Initials:

Comments (Continued):

(A copy of this report is to remain at job-site with the contractor for review by the building department's inspector upon request.)
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(A copy of this report is to remain at job-site with the contractor for review by the building department's inspector upon request.)
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Date:
Project:
Contractor Initials:

Comments (Continued):

(A copy of this report is to remain at job-site with the contractor for review by the building department's inspector upon request.)
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(A copy of this report is to remain at job-site with the contractor for review by the building department's inspector upon request.)
 Sequence No.

Truck No.

Cubic Yards Carried

F: (919) 380-8752
P: (919) 380-8750

Total Cubic Yards Delivered

Morrisville, NC 27560

Placement Location:
260 Town Hall Drive, Suite C
Stewart Engineering, Inc.

Ticket Number

Batch Time

Arrival Time

Final Placement Time

Elapsed Time
Concrete Mix Design:
Project :

No. Drum Revolutions

Concrete Placement Chart

Initial Slump
Date :

Final Slump

Air Percentage (%)

Material Temperature

Gallons of Water Added

Temperature :

Admixture Added (Y/N)

No. Samples Taken

Out of Specifications (Y?N)