Concrete Mix Design Submittal Form
Page 1 of 3 Rev 2018
Water Reducer Admix. (WRA)
Set Retarder Admix.
Set Accelerator Admix.
Total Batch Weights
Coarse Aggregate (2)
Fine Aggregate (Natural)
Fine Aggregate (Manufactured)
Portland Cement
Fly Ash
GGBF Slag
Air Content
Air Entraining Admix. (AEA)
Fly Ash
Mix Ingredient
Portland Cement
GGBF Slag
Designation
The concrete mix no. and designation is used by the contractor to order the concrete, this information is also printed on all delivery tickets
Design Water/Cementitious Ratio (w/cm)
C 989
Manufacturer
I. Mix Design One Cubic Yard Batch Weights and Volumes
Concrete Producer Date
Specific GravityAmount
lbs.
Volume (ft3)
Design Compressive Strength (psi) ƒ'c
Mix Ingredient
Coarse Aggregate (1)
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs. TotalVolume
Total cement content includes cement + pozzolans
Contractor Concrete Mix No.
Theoretical Unit Weight: Design Slump without WRA with WRA
%
oz/cy
oz/cy
oz/cy
oz/cy
cu. ft.
Source
II. Cementitous Materials
Type, Class, Grade
Type I, II, or III
Class C or F
Grade 100 or 120
ASTM Standard
C 150
C 618
oz/cy
Water: ___________ gal Water
Concrete Mix Design Submittal Form
Page 2 of 3 Rev 2018
Min. Max.
Fine Aggregate (Natural)
Fine Aggregate (Manufactured)
Air Entraining Admixtures shall meet the requirements of ASTM C260, all other admixtures shall meet the requirements of ASTM C 494
Admixture Type Manufacturer Brand Name
Percent ofTotal Weight
FM
Coarse Aggregate (2)
V. Aggregates
Air Entraining
Water Reducing
Set Retarding
Set Accelerating
High Range Water Reducer
Source
The concrete supplier certifies that total chloride ion content of the concrete mix, does not exceed the amounts specified in Table 4.4.1 of ACI 318-12.
IV. Water
FM
Size
Manufacture's Recommended Dose
Range per CWT
III. Admixtures
Potable water shall be used unless the city engineer approves reclaimed / recycled non-potable water
Mix Ingredient
Coarse Aggregate (1)
Concrete Mix Design Submittal Form
Page 3 of 3 Rev 2018
Include as attachments
V. Submittals
Strength testing data representing materials used and meeting the physical properties of chapter 6 of the General Conditions and Technical Specifications for air content, slump, and temperature.
Manufacture's data sheet for each admixture with recommended dosage range.
Mill certificates for each cement and pozzolan used in mix design
Sieve analysis of each aggregate, include specific gravity, absorption, and unit weight test results, dated within the last year.
If the mix water is non-potable, the concrete producer certifies that the mix water meets the requirements of ASTM C 1602 for sulfate, chloride, alkalies, and total solids. Include testing results
Remarks/Comments