Form MTRB VJC-3A "Concrete & Grout Strength Test Report" - Hawaii

What Is Form MTRB VJC-3A?

This is a legal form that was released by the Hawaii Department of Transportation - a government authority operating within Hawaii. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on February 4, 2016;
  • The latest edition provided by the Hawaii Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form MTRB VJC-3A by clicking the link below or browse more documents and templates provided by the Hawaii Department of Transportation.

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Download Form MTRB VJC-3A "Concrete & Grout Strength Test Report" - Hawaii

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MTRB VJC-3a 2/4/2016
STATE OF HAWAII DEPARTMENT OF TRANSPORTATION HIGHWAYS DIVISION - MATERIALS TESTING AND RESEARCH BRANCH
Print in Color or on Blue Paper
CONCRETE & GROUT STRENGTH TEST REPORT
HWY-LS
District Lab
Sample No:
VJC-
Project No:
Date:
Project:
Island:
Charge Code/Work Order:
Sampled By:
Date & Time Sampled:
Concrete/Grout Supplier:
Plant Location:
Type of Concrete/Grout:
Concrete Mix No.:
Truck No:
Time Concrete Left Plant:
Quantity Water Added on Jobsite (gal):
Slump (C143/T119):
Temperature (C1064):
Cubic Yards in Truck When Water Added:
Density (C138/T121):
Air Content (C231/T152 or C173/T196):
Grout Flow (C939):
Unit of Concrete/Grout Sampled:
Quantity of Concrete/Grout Represented:
Concrete/Grout is Being Used In:
Pay Item No.:
Cover with Removable lid
Other method:
Initial Curing Method:
Curing Temperature
Max:
Min:
Remarks:
Submitted By:
E-mail:
Phone No.:
Agency:
For HWY-L and District Lab Use
ID
Test Age
Weight
Density
Diameter
Length
Area
Max Load
Strength
Frac.
Tested
Test Date
Remarks
(Days)
(gms)
(lbs/cf)
(in)
(in)
(sq in)
(lbs)
(psi)
Type
By
No.
A
B
C
C
D
E
F
G
H
I
TEST METHOD
FRACTURE TYPE
Sample Received By & Date:
C39/T22
C78/T97
Condition of Sample:
2
3
1
C109/T106
C617/T231
C/1231
4
5
6
Other:
Accepted
Accepted
Failed Specified Strength
Failed Specified Strength
Other
Other
Contact Name/E-Mail:
Reviewer:
Date:
MTRB VJC-3a 2/4/2016
STATE OF HAWAII DEPARTMENT OF TRANSPORTATION HIGHWAYS DIVISION - MATERIALS TESTING AND RESEARCH BRANCH
Print in Color or on Blue Paper
CONCRETE & GROUT STRENGTH TEST REPORT
HWY-LS
District Lab
Sample No:
VJC-
Project No:
Date:
Project:
Island:
Charge Code/Work Order:
Sampled By:
Date & Time Sampled:
Concrete/Grout Supplier:
Plant Location:
Type of Concrete/Grout:
Concrete Mix No.:
Truck No:
Time Concrete Left Plant:
Quantity Water Added on Jobsite (gal):
Slump (C143/T119):
Temperature (C1064):
Cubic Yards in Truck When Water Added:
Density (C138/T121):
Air Content (C231/T152 or C173/T196):
Grout Flow (C939):
Unit of Concrete/Grout Sampled:
Quantity of Concrete/Grout Represented:
Concrete/Grout is Being Used In:
Pay Item No.:
Cover with Removable lid
Other method:
Initial Curing Method:
Curing Temperature
Max:
Min:
Remarks:
Submitted By:
E-mail:
Phone No.:
Agency:
For HWY-L and District Lab Use
ID
Test Age
Weight
Density
Diameter
Length
Area
Max Load
Strength
Frac.
Tested
Test Date
Remarks
(Days)
(gms)
(lbs/cf)
(in)
(in)
(sq in)
(lbs)
(psi)
Type
By
No.
A
B
C
C
D
E
F
G
H
I
TEST METHOD
FRACTURE TYPE
Sample Received By & Date:
C39/T22
C78/T97
Condition of Sample:
2
3
1
C109/T106
C617/T231
C/1231
4
5
6
Other:
Accepted
Accepted
Failed Specified Strength
Failed Specified Strength
Other
Other
Contact Name/E-Mail:
Reviewer:
Date: