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Michigan Department of Transportation
0590 (04/19)
FIELD AND LAB TEST REPORT To be completed by the QA inspector and included in the final project documentation.
REPORT #
GENERAL INFORMATION INSPECTION AGENCY INSPECTOR DATE
FABRICATOR / LOCATION CONTROL SECTION
JOB DESCRIPTION SIZE AND ELEMENT TYPE JOB NUMBER
STRENGTH REQUIRED
SERIES STRIPPING STRENGTH (PSI) TRANSFER STRENGTH (PSI) 28-DAY STRENGTH (PSI)
FIELD TEST DATA
TIME AIR (%) SLUMP (IN) CONCRETE (°F) AIR (°F)
QC TESTER:
QA TESTER:
STRIPPING/TRANSFER STRENGTH RESULTS
CYLINDER MARKS TEST DATE TEST AGE CYL 1 (PSI) CYL 2 (PSI) CYL 3 (PSI) APPROVED INSPECTOR
28 DAY STRENGTH RESULTS
CYLINDER MARKS TEST DATE TEST AGE CYL 1 (PSI) CYL 2 (PSI) CYL 3 (PSI) AVG (PSI) APPROVED INSPECTOR
SHIPPING INFORMATION
ELEMENT MARK DATE SHIPPED INSPECTOR APPROVED COMMENTS
ELEMENT MARKS
SUBLOT 1 CYLINDER MARKS
SUBLOT 2 CYLINDER MARKS
SUBLOT 3 CYLINDER MARKS
COMMENTS
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