Concrete Mix Design Submittal Transmittal Form

Project Name

Project Number

Owner / Client

Contractor

Submittal Number

Date Submitted

Submitted By

Contact Information

Mix Design Information

Mix Design ID / Reference

Intended Use

Strength Requirement (psi/MPa)

Slump (in/mm)

Air Content (%)

Maximum Aggregate Size

Water/Cement Ratio

Admixtures

Comments / Special Requirements

Attachments

List all attached documents (e.g., test reports, certifications):