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BUILDING & SAFETY <br />SPECIAL INSPECTION REPORT <br />85 <br />Project/Construction Manager Approval/Si gnature <br />Project/construdion Mana8er Name: Robert Ramiro <br />(562)241,1333 <br />DATEI <br />PROJTCTADDRESS: <br />TYPE OF IN5PECTION <br />LOIrO/78 <br />VENTANA WAIX - PHAsI 4 SLDG *5 l-ot r 34 Plan 4C <br />EPOXY <br />Print Name: Samuel chaly <br />(949) 23s-0Ss2 <br />WOR( OESCRIFTION: <br />Observed the preparation and placement of Epo)ry for concrete repair. <br />#4 Dowels @ 16"oc with 5" min. embed. using Simpson Set Epoxy XP ICC ESR # 2508 <br />Holes were cleaned with brush and compressed ak. <br />Work on this job has been satisfactorily completd in conformance with approved plans and the <br />requirements ofthe City of Santa Ana. <br />Signature <br />-a <br />CITY OF SANTA ANA <br />R*,