Certification of Concrete Quality - Illinois

This Illinois-specific printable "Certification of Concrete Quality" is a part of the legal paperwork issued by the Illinois Department of Agriculture.

Download the up-to-date PDF by clicking the link below and mail it as per the guidelines provided by the department.

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C
C
Q
ERTIFICATION OF
ONCRETE
UALITY
Facility Name:
___________________________________
Facility ID:
___________________________________
Concrete Company Name:
___________________________________
Address:
___________________________________
City/State/Zip code:
___________________________________
Phone #:
___________________________________
I herby certify, to the best of my knowledge, the concrete mixed and delivered to the
aforementioned project met or exceeded the minimum compressive strength (28 day) and
quality control requirements as stated in the facility’s Department approved construction
plan. Below is a listing of the concrete mixed and delivered by our company to the
aforementioned project.
_______________________________________
____/____/____
Date
Concrete Company Representative Signature
Minimum
Concrete Mix
Delivery
Quantity
Compressive
3
Load Identification
Date
(yd
)
Strength (28-day)
Submit to:
Illinois Department of Agriculture
Livestock Management Facilities Program
P.O. Box 19281 -- State Fairgrounds
Springfield, IL 62794-9281
217/785-2427
217/524-4882 (fax)
C
C
Q
ERTIFICATION OF
ONCRETE
UALITY
Facility Name:
___________________________________
Facility ID:
___________________________________
Concrete Company Name:
___________________________________
Address:
___________________________________
City/State/Zip code:
___________________________________
Phone #:
___________________________________
I herby certify, to the best of my knowledge, the concrete mixed and delivered to the
aforementioned project met or exceeded the minimum compressive strength (28 day) and
quality control requirements as stated in the facility’s Department approved construction
plan. Below is a listing of the concrete mixed and delivered by our company to the
aforementioned project.
_______________________________________
____/____/____
Date
Concrete Company Representative Signature
Minimum
Concrete Mix
Delivery
Quantity
Compressive
3
Load Identification
Date
(yd
)
Strength (28-day)
Submit to:
Illinois Department of Agriculture
Livestock Management Facilities Program
P.O. Box 19281 -- State Fairgrounds
Springfield, IL 62794-9281
217/785-2427
217/524-4882 (fax)
Minimum
Concrete Mix
Delivery
Quantity
Compressive
3
Load Identification
Date
(yd
)
Strength (28-day)

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