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PROJECT INFORMATION:
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Client:
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Contact Name:
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First
Last
Project Name:
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Phone Number
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Email
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Postal Address (Client)
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Line 1
Line 2
City
State
Zip Code
Country
Fisical Address (Project)
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Line 1
Line 2
City
State
Zip Code
Country
MIX - 1:
Yds. Qty.
*
Mix Type
*
Select One
Regular Mix
Pump Mix
Grout Mix (Mortero)
Strenght
*
Select One
1,000 psi
1,500 psi
2,000 psi
2,500 psi
3,000 psi
3,500 psi
4,000 psi
4,500 psi
5,000 psi
5,500 psi
6,000 psi
W / C Ratio
*
Select One
N/A
.30
.35
.40
.45
.50
.55
.60
.65
.70
.75
.80
.85
.90
.95
Cement Type
*
Select One
Type I
IS - 40%
Slump
*
Select One
2"
3"
4"
5"
6"
7"
8"
9"
10"
Temperature (°F)
*
Select One
95 - UP
90 - UP
85
80
Coarse Aggregate
*
Select One
3/8
1/2
3/4
1
N/A (Grout Mix)
Fine Aggregate
*
Select One
Natural
Manufactured
Fly Ash
*
Select One
N/A
10%
15%
20%
25%
30%
35%
40%
45%
50%
Other (Choose Any that Apply)
*
Microfiber (Polypropylene)
Macrofiber (STRUX 90/40)
Steelfiber
Corrosion Inhibitor (DCI-S)
Slip Form Mix
Waterproofing (Rheomac 300D)
Water Repellent (Darapel)
N/A
MIX - 2:
Yds. Qty.
*
Mix Type
*
Select One
Regular Mix
Pump Mix
Grout Mix (Mortero)
Strength
*
Select One
1,000 psi
1,500 psi
2,000 psi
2,500 psi
3,000 psi
3,500 psi
4,000 psi
4,500 psi
5,000 psi
5,500 psi
W / C Ratio
*
Select One
N/A
.30
.35
.40
.45
.50
.55
.60
.65
.70
.75
.80
.85
.90
.95
Concrete Type
*
Select One
Type I
IS - 40%
Slump
*
Select One
2"
3"
4"
5"
6"
7"
8"
9"
10"
Temperature (°F)
*
Select One
95 - UP
90 - UP
85
80
Coarse Aggregate
*
Select One
3/8
1/2
3/4
1
N/A (Grout Mix)
Fine Aggregate
*
Select One
Natural
Manufactured
Fly Ash
*
Select One
N/A
10%
15%
20%
25%
30%
35%
40%
45%
50%
Other (Choose Any that Apply)
*
Microfiber (Polypropylene)
Macrofiber (STRUX 90/40)
Steelfiber
Corrosion Inhibitor (DCI-S)
Slip Form Mix
Waterproofing (Rheomac 300D)
Water Repellent (Darapel)
N/A
MIX - 3:
Yds. Qty.
*
Mix Type
*
Select One
Regular Mix
Pump Mix
Grout Mix (Mortero)
Strenght
*
Select One
1,000 psi
1,500 psi
2,000 psi
2,500 psi
3,000 psi
3,500 psi
4,000 psi
4,500 psi
5,000 psi
5,500 psi
6,000 psi
W / C Ratio
*
Select One
N/A
.30
.35
.40
.45
.50
.55
.60
.65
.70
.75
.80
.85
.90
.95
Cement Type
*
Select One
Type I
IS - 40%
Slump
*
Select One
2"
3"
4"
5"
6"
7"
8"
9"
10"
Temperature (°F)
*
Select One
95 - UP
90 - UP3
85
80
Coarse Aggregate
*
Select One
3/8
1/2
3/4
1
N/A (Grout Mix)
Fine Aggregate
*
Select One
Natural
Manufactured
Fly Ash
*
Select One
N/A
10%
15%
20%
25%
30%
35%
40%
45%
50%
Other (Choose Any that Apply)
*
Microfiber (Polypropylene)
Macrofiber (STRUX 90/40)
Steelfiber
Corrosion Inhibitor (DCI-S)
Slip Form Mix
Waterproofing (Rheomac 300D)
Water Repellent (Darapel)
N/A
MIX - 4:
Yds. Qty.
*
Mix Type
*
Select One
Regular Mix
Pump Mix
Grout Mix (Mortero)
Strenght
*
Select One
1,000 psi
1,500 psi
2,000 psi
2,500 psi
3,000 psi
3,500 psi
4,000 psi
4,500 psi
5,000 psi
5,500 psi
6,000 psi
W / C Ratio
*
Select One
N/A
.30
.35
.40
.45
.50
.55
.60
.65
.70
.75
.80
.85
.90
.95
Cement Type
*
Select One
Type I
IS - 40%
Slump
*
Select One
2"
3"
4"
5"
6"
7"
8"
9"
10"
Temperature (°F)
*
Select One
95 - UP
90 - UP
85
80
Coarse Aggregate
*
Select One
3/8
1/2
3/4
1
N/A (Grout Mix)
Fine Aggregate
*
Select One
Natural
Manufactured
Fly Ash
*
Select One
N/A
10%
15%
20%
25%
30%
35%
40%
45%
50%
(Choose Any that Apply)
*
Microfiber (Polypropylene)
Macrofiber (STRUX 90/40)
Steelfiber
Corrosion Inhibitor (DCI-S)
Slip Form Mix
Waterproofing (Rheomac 300D)
Water Repellent (Darapel)
N/A
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