Rice Lake CB-2 Concrete Batch Controller Version 2.0 - Manual (Page 79)

Installation/Operation Manual - Appendix 75
10.11 MNDot Conversion
________________________________
| Certificate of Compliance |
A
________________________________
Ticket# 3950 Thursday 06/03/2010
________________________________
| Rice Lake Concrete |
| 139 Wisconsin Ave. |
| Rice Lake WI |
B
| 54868 |
| Plant: Edmonton Facility |
________________________________
__________________________________
CUSTOMER: Dave's Concrete | SITE: State Bldg. |
| 21 Main St. |
____________________________________| Rice Lake WI 54868 |
| |
|INSTRUCT: west driveway NOTES: deposit load ticket |
| turn right at contractors bldg |
C
| stop at contractors bldg |
| contact foreman |
| dump where directed |
______________________________________________________________________
___________________________________________
ORDER: 2
D
| State Project #123456789, Bridge #987654321|
___________________________________________
LOAD ID: 2004308 TRUCK: 1 DRIVER: Jones LOADED AT: 03:23AM
MIX: 1 DESC: 2500# Footing
LOAD QTY: 1 DELIVERED (INCLUDING THIS LOAD): 6 ORDERED: 20 CY
BATCH ID: 3004302 BATCH QTY: 1.00 MANUAL: Yes TIME WEIGHED: 03:21 AM
Ingredient Source MCFac AbsFac OD Abs SSD FMST CYTarg Target Actual %Err
------------------ ----- ------ --- --- --- ---- ------ ------ ------ ----
3/4 Inch 0.000 0.000 1260 0 1260 0 1260.0 1260 1300 lb 3.17
Sand 0.025 0.000 1650 0 1650 41 1691.3 1691 1700 lb 0.53
Cement 350 350.0 350 360 lb 2.86
Water 23.0 18.0 18 18 Gl 0.00
Air Polychem VR 0.20/H 0.70 1 1 oz 0.00
Total Water: 192 lb
Available Water: -0.1 gal
Water added to truck at plant: ________ gal
Water added to truck at jobsite: ________ gal
Total Actual Water: ________ lb
Air Temperature: ________
Concrete Temperature: ________
Slump: ________
Cylinder Number: ________
Structure Part: ___________________________________
Time Discharged: _________________
Air Content: _________________
Producer's Representative Signature: __________________________________________
Inspector's Signature: __________________________________________
SLUMP: 4.0 in WATER ADJUST: -0.05 Gal/Yard WAT/CEM RATIO: 0.53 FOR LOAD