Report No.

Concrete Placement Record

Page: ../...

Client:

Subcontractor:

Foundation/Structure No.:

Project No.:

Subcontract P.O. No.:

Concrete Supplier:

Name of Project:

Grade/Mix Design No.:

Reference document

Slump max/min .......................... cm

Temperature min ........................ C

Theoretical volume ..................... m3

Delivery*
Note No.

Truck
No.

Batch
Time

Start Pour
Date/time

Finish Pour
Date/time

Volume/Accum.
Volume m3

Temp.
C

Measured
Slump

No. cylinders
made

Cylinder
Ref. No.

Remarks

* Attachments, No. of pages

Accepted for Subcontractor

Accepted for Company

Accepted for Client

Name:

Name:

Name:

Signature:

Signature:

Signature:

Date:

Date:

Date:

C:\RB_Forms\RB26J04.DOT\

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