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FESF"GEAUJWEE 1/VC. Date: -7 _2-L(-2-ea DSA File#: DSA App.#: Project#: L� OSHPD#: Project Name: Permit/SF App.#: Address: �� Tow Code: (!�—a City: 14' Start Time: 'C Aam Requested by: t Hours: Reported to F5.11 'e 149 374 1'1 sU k of(Company Name): Proof Load Testing Report(150) Applied a Rtension proof or D torque load of ► bs.or 0 ft.-lbs, to _',<;`� (size)diameter 47T 1�_ (brand) ❑epoxied dowels [2 epoxied Allthread anchors ❑expansion anchors ❑,�°wder actuated pins other: Located in the E floor u wall ❑ ceiling ❑ other at ;-,k .r,l� 5 _c1,2 } c,.A .,u l a� / '�� (location) for (No.)anchors/dowels of a total of ` installed were tested representing t percent [� without visually apparent distress or failure. ❑ (Na)anchors/dowels failed to meet proof load requirements. Identified and reported failing anchors/dowels to at the jobsite for appropriate action. Applied aE1 tension proof or torque load of ❑lbs.or❑ft.lbs, to (size)diameter (brand) ❑epoxied dowels ❑ epoxied Allthread anchors ❑expansion anchors ❑,p°powder actuated pins other: Located in the ❑ floor u wall El ceiling 11 other at (location) for (No.) anchors/dowels of a total of installed were tested representing percent ❑ without visually apparent distress or failure. ❑ (No.)anchors/dowels failed to meet proof load requirements. Identified and reported failing anchors/dowels to at the jobsite for appropriate action. .Proof loading values and rate of testing were supplied by [R Drawings S 1 - No(s) ❑ Other ❑ Final acceptance is pending written approval or corrective action as noted ❑See attached RFI. ❑ All non-compliance items were brought to the attention of at the job site. Note: ❑Showup;❑Stand-by time;❑Job Cancelled;❑Re-inspection;Hours: The work 13 was❑was not inspected in accordance with the fR Building Department or ❑ DSA or ❑ OSHPD approved documents. The work respected R met❑did not meet the requirements of the Q Building Department or ❑ DSA or ❑ OSHPD approved documents, ❑except as noted above. Drawings >1 , Dated Z`13-2 'Zll? R_City ❑ County ❑DSA ❑ Shop Inspector a �I ? f Certification# l Date: Received by: 1 'I v I !, �C C�i Date: / (��✓� Corporate Office-2811 Teagarden Street-San Leandro,California 94577-(510)835-3142-FAX(510)834-3777 www,Testina-Enaineers.com