February 1, 1998
36 ATTACHMENT #3
Division of Local Assistance, Office of Procedures Development and Training Quality Assurance Program (QAP) Manual for Use by Local Agencies Revised January 20, 2011 Appendix F - Construction Materials Accepted by a Certificate of Compliance *
Soil Amendment
Fiber
Mulch
Stabilizing Emulsion
Plastic Pipe
Lime
Reinforcing Steel
Structural Timber and Lumber
Treated Timber and Lumber
Timber and Lumber
Culvert and Drainage Pipe Joints
Reinforced Concrete Pipe
Corrugated Steel Pipe and Corrugated Steel Pipe Arches
Structural Metal Plate Pipe Arches and Pipe Arches
Perforated Steel Pipe
Polyvinyl Chloride Pipe and Polyethylene Tubing
Steel Entrance Tapers, Pipe Down drains, Reducers, Coupling Bands and Slip Joints Aluminum Pipe (Entrance Tapers, Arches, Pipe Down drains, Reducers, Coupling Bands and Slip Joints) Metal Target Plates
Electrical Conductors
Portland Cement
Minor Concrete
Waterstop
* If Caltrans Standard Specifications May 2006 is part of contractspecifications.
Note: Usually these items are inspected at the site of manufacture or fabrication and reinspected after delivery to the job site.
37 ATTACHMENT #4
Division of Local Assistance, Office of Procedures Development and Training Quality Assurance Program (QAP) Manual for Use by Local Agencies Revised January 20, 2011 Appendix J.1 - Example of a Vendor’s Certificate of Compliance 38 Division of Local Assistance, Office of Procedures Development and Training Quality Assurance Program (QAP) Manual for Use by Local Agencies Revised January 20, 2011 Appendix J.2 - Example of a Certificate of Compliance for Portland Cement (continued)
Date: 07/07/07 .
Quality Assurance Engineer
ABC Cement Company
Local Agency Project No.
HP21L – 5055 – 111
Supplied by ABC Cement Company complies with all
requirements for Type II Portland Cement when tested in accordance with ASTM C - 494.
Portland Cement .
This is to certify that the
39 ATTACHMENT #5
Division of Local Assistance, Office of Procedures Development and Training Quality Assurance Program (QAP) Manual for Use by Local Agencies Revised January 20, 2011 Appendix K - Examples of Materials Certificates/Exceptions (Signed by the Resident Engineer at the Completion
of the Project)
Federal-aid Project No.: Project HP21L – 5055 – 111
Subject: Materials Certification
This is to certify that the results of the tests on acceptance samples indicate that the materials incorporated in the construction work and the construction operations controlled by sampling and testing were in conformity with the approved plans and specifications.
All materials exceptions to the plans and specifications on this project are noted below.
No exceptions were found to the plans and specifications on this project.
Bill Sanders Bill Sanders 7/7/07
Resident Engineer (Print Name) Resident Engineer (Signature) (Date) Note: The signed original of this certificate is placed in the Resident Engineer’s project files and one copy is mailed to the DLAE and filed under “Report of Expenditures.” See the attachment (next page)
40 Division of Local Assistance, Office of Procedures Development and Training Quality Assurance Program (QAP) Manual for Use by Local Agencies Revised January 20, 2011 Appendix K
(continued)
Attachments: Materials Exceptions (Acceptance Testing)
Type of
Test
Description
of Work
Total Tests
Performed On
the Project
Number
of Failed
Tests
Action Taken
Slump Test Concrete
Sidewalk
8 1 When the measured slump exceeded the
maximum limit, the entire concrete load was
rejected.
Sand
Equivalent
Aggregate
for Structural
Concrete
10 1 The tested S.E. was 70 and the contract
compliance specification was 71 minimum.
However, the concrete 28-day compressive
strength was 4800 psi. The concrete was
considered adequate and no materials
deductions were taken.
Compaction Sub grade
Material
12 1 One failed test was noted. The failed area was
watered and reworked. When this was
completed, a retest was performed. The retest
was acceptable.
Compaction Hot Mix Asphalt12 1 One failed area was noted. It was reworked and retested. The second test met
specifications.
Bill Sanders Bill Sanders July 4, 2007
Resident Engineer (Print Name) Resident Engineer (Signature) Date 35 ATTACHMENT #6
Division of Local Assistance, Office of Procedures Development and Training Quality Assurance Program (QAP) Manual for Use by Local Agencies Revised January 20, 2011 Appendix H - Example of a Log Summary Sheet
Subgrade Materials
Date CT Station Elevation Test
Results
Minimum
Spec.
Passed
or Failed
Action
Taken
5/15/07 231 1+ 00 (30’ L) 99.00 93 90 or greater Passed N/A 5/16/07 231 1+ 50 (20’ R) 100.50 94 90 or greater Passed N/A 5/17/07 231 2+ 25 (25’ R) 101.00 96 90 or greater Passed N/A 5/18/07 231 1+ 50 (30’ L) 101.50 95 95 or greater Passed N/A 5/19/07 231 2+ 50 (20’ L) 102.00 92 * 95 or greater Failed See Note 1 5/19/07 231 2+ 50 (20’ L) 102.00 95 95 or greater Passed N/A CT 231 = Compaction (Nuclear Gage)
* Note 1: The Contractor used a water tank to dampen the soil surface at the failed subgrade location. Using a sheep’s foot compactor, he reworked the subgrade (making at least 10 passes) from Station 2+ 00 to Station 3+ 00. After approximately 30 minutes, another compaction test was taken. This time the relative compaction was 95.
Aggregates and Base Materials
Date CT Station Elevation Test ResultsMinimum
Spec.
Passed
or Failed
Action
Taken
6/20/07 202 1+ 00 (10’ R) 102.50 See data
sheet
See data sheet Passed N/A
6/20/07 202 2+ 00 (20’ L) 102.50 See data
sheet
See data sheet Passed N/A
6/22/07 217 1+ 00 (10’ R) 102.50 75 25 or greater Passed N/A 6/22/07 217 2+ 00 (20’ L) 102.50 83 25 or greater Passed N/A 6/20/07 227 1+ 00 (20’ R) 102.50 86 71 or greater Passed N/A 6/20/07 227 1+ 50 (20’ L) 102.50 85 71 or greater Passed N/A 6/24/07 231 2+ 00 (20’ R) 102.50 98 95 or greater Passed N/A 6/24/07 231 2+ 50 (20’ L) 102.50 97 95 or greater Passed N/A CT 202 = Sieve Analysis, CT 217 = Sand Equivalent, CT 227 = CleannessValue, CT 231 = Compaction (NuclearGage)
34 Division of Local Assistance, Office of Procedures Development and Training Quality Assurance Program (QAP) Manual for Use by Local Agencies Revised January 20, 2011 Appendix H (continued)
Hot Mix Asphalt
Date CT Station Elevation Test Minimum Passed or Action Results Spec. Failed Taken
7/10/07 339 1+ 00
(10’ R)
103.00 0.08 gal/
sq yd
0.05 -0.10
gal/sq yd
Passed N/A
7/10/07 366 2+ 00
(20’ L)
103.00 32 >23 Passed N/A
7/10/07 366 1+ 00
(10’ R)
103.00 41 >23 Passed N/A
7/10/07 375 2+ 00
(20’ L)
103.00 94 RC = 93 to
97 Passed N/A
7/15/07 375 1+ 00
(20’ R)
103.00 96 RC = 93 to
97 Passed N/A
7/15/07 375 1+ 50
(20’ L)
103.00 95 RC = 93 to
97 Passed N/A
CT 339 = DistributorSpread Rate, CT 366 = StabilometerValue CT 375 = In-Place Density & Relative Compaction
Portland Cement Concrete
Date CT Station Elevation Test Minimum Passed or Action Results Spec. Failed Taken
9/25/07 504 10 + 50
(50’ R)
102.50 6.5% >6.0% Passed N/A
9/25/07 533 12 + 50
(50’ R)
102.50 1.5” <2” Passed N/A
9/25/07 518 11 + 50
(50’ R)
102.50 151 lb/cu ft > 145 lb/cu
ft
Passed N/A
9/25/07 521 10 + 50
(50’ R)
102.50 28 day =
4200 psi
>3800 psi Passed N/A
9/28/07 521 11 + 50
(50’ R)
102.50 28 day =
4290 psi
>3800 psi Passed N/A
9/30/07 521 12 + 50
(50’ R)
102.50 28 day =
4160 psi
>3800 psi Passed N/A
CT 504 = Air Content, CT 518 = Unit Weight, CT 521 = Compressive Strength CT 533 = Ball Prenetration