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Concrete QC Test Report
General Information
Date
Company
CIRM
IRM
CSI
Plant Number
COMPANY
Location
Weather Conditions
Clear
Overcast
Windy
Hot
Warm
Cold
Rain
Fog
Snow
High Temp (°F)
Low Temp (°F)
Personnel
Project No.
Contractor
Name
Cert. #
Cell #
Plant Inspector
Plant Monitor
On Site Inspector
Mix & Moisture
Mix
Coarse
Fine
Int.
Moistures
Ag. Percentages
Sources
# (Amount)
SPG
Coarse
Fine
Int.
Cement
NA
Fly Ash
NA
Slag
NA
Admixtures
Mfg.
Lot #
Dosage
Air Agent
Retarder
Water Reducer
Mid/High Range
Type
Dosage
Fiber
Plant Water
gal/cy
Heated
Yes
Grade Water
total
Total Yardage
Start Time
Stop Time
Notes