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Project Location
Consultant Contractor
Prepared by …………………………………………………………………………………………………………………
Name Designation Office Date
Total vol. Of cement, water, coarse aggregate, air and admixture _________cu. m.
Volume of Fine Aggregate _______cu. m. Weight of F.A __________kg.
Design Mix(before adjustment for moisture and Absorption):
Remarks: ________________________________________________________
________________________________________________________________
Recommended – yes/no.
Contractor ___________________________
(Signature, date and name)
Project: Date:
Consultant: Contractor:
Fine Aggregate:
Obtained Specified Limit
Fineness Modulus _________ 2.3---3.1
Sodium Soundness _________ Maximum 10%
Friable Particles _________ Max. 1%
Organic Impurities ________ Lighter
Sand Equivalent ________ Minimum 75%
Gradation:
Sieve Size %Passing %Passing
3/8” ________ 100
#4 ________ 95—100
#8 ________ ------
#16 ________ 45---80
#30 ________ ------
#50 ________ 10---30
#100 ________ 2---10
#200 ________ Max.4%
Coarse Aggregate :
Obtained Specified Limit
Abrasion ________ Maximum 40%
Sodium Soundness ________ Max. 12%
Friable Particles ________ Max. 1%
Soft Fragments and Shales ________ Max. 5%
Thin and Elongated Pieces ________ Max. 15%
Alkali Reactivity ________ Innocuous
Use another page for Petrographic Examination and other tests, If required.
Gradation:
Sieve Size %Passing %Passing
2” ________ ________
1 ½” ________ ________
¾” ________ ________
½” ________ ________
3/8” ________ ________
#4 ________ _________
#8 ________ _________
#200 ________ Max. 1%
All test required in the specification have been performed and showed that the materials including
water, cement and admixture satisfied all requirements.
Signature:
Name ____________ _______________ _______________
Contractor Material Engineer Res. Engineer.