500Rigid Pavement

501 Portland Cement Concrete Pavement (QC/QA)Concrete Pavement (**)(**)(**) 501 - 1Quality Control Testing Concrete Pavement (**)(**)(**) 501 - 2Record of Tested Material Received and Used 501 - 1ARecord of Certified Cement Received and Used 501 - 1BRecord of Moisture Tests - (Check Tests at Concrete Plant) 501 - 1CConcrete Test Data 501 - 1DConcrete - Width, Depth, Steel Depth & Crown Information 501 - 1ERecord of Cores Taken 501 - 1FSealing of PCCP Joints 501 - 1GRecord of Tie-Bar Insertion 501 - 1HSketch and Computations for Concrete Pavement 501 - 1IDensity Tests 501 - 1J

502 Portland Cement Concrete Pavement (Non-QC/QA)Concrete Pavement (**)(**)(**) 501 - 1Record of Tested Material Received and Used 501 - 1A

Plate

Record of Certified Cement Received and Used 501 - 1BRecord of Moisture Tests - (Check Tests at Concrete Plant) 501 - 1CConcrete Test Data 501 - 1DConcrete - Width, Depth, Steel Depth & Crown Information 501 - 1ERecord of Cores Taken 501 - 1FSealing of PCCP Joints 501 - 1GRecord of Tie-Bar Insertion 501 - 1HSketch and Computations for Concrete Pavement 501 - 1I

503 Portland Cement Concrete Pavement SmoothnessRecord of Concrete Pavement Smoothness 503 - 1Recap of Concrete Pavement Smoothness 503 - 1ARecap of Bumps 503 - 1B

Record of Aggregate Gradations 504 - 1Ready Mix Trucks 504 - 2Cement Scale Checks 504 - 3Vibrator Checks 504 - 4Haul Trucks Idenfication 504 - 5Random Operation Checks for Slipform Paver. 504 - 6

Line

#:

Plan

Qnt

y:(*

**)

Dat

eLa

neLe

ngth

Wid

thIn

sp.

(***

) Pla

ced

Est

. No.

___

CO

NC

RET

E PA

VEM

ENT

(*)(*

*)(A

E)

Acc

um.

(***

) Pla

ced

Rem

arks

Loca

tion

Sta

tion

to S

tatio

n

This

pla

te is

des

igne

d to

be

used

for c

oncr

ete

base

, con

cret

e pa

vem

ent,

conc

rete

pav

emen

t and

ear

lyst

reng

th p

ortla

nd c

emen

t. T

his

is a

dai

ly re

capi

tula

tion

of q

uant

ities

and

is to

be

used

for e

stim

ate

purp

oses

.

This

pla

te m

ay b

e us

ed fo

r Bon

ded

Con

cret

e Pa

vem

ent,

Con

cret

e Bl

ock

Pave

men

t, C

oncr

ete

Bond

ed O

verla

y,C

oncr

ete

Bond

ed O

verla

y Pl

acem

ent O

nly,

Con

cret

e C

anal

Lin

ing,

Con

cret

e C

hann

el P

avin

g, C

oncr

ete

Shou

lder

,C

orru

gate

d C

oncr

ete

Div

ider

s, E

arly

Stre

ngth

Con

cret

e Pa

vem

ent,

Grin

ding

Con

cret

e Su

rface

, Rei

nfor

ced

Con

cret

eO

verla

y, R

ubbl

ized

Con

cret

e, C

oncr

ete

Plac

emen

t, an

d Br

idge

App

roac

h.

(*) T

hick

ness

(**)

Uni

form

or V

aria

ble

(***

) Uni

t of M

easu

re

501-1

Line

#:

Plan

Qnt

y:

Dat

eLa

neLe

ngth

Wid

thIn

sp.

Qua

lity

Con

trol

Tes

ting

CO

NC

RET

E PA

VEM

ENT

(*)(*

*)(A

E)

Acc

um.

(***

) Tes

ted

Rem

arks

Sta

tion

to S

tatio

n

Loca

tion

(***

)

Est

. No.

___

(***

) Tes

ted

This

pla

te is

des

igne

d to

be

used

for c

oncr

ete

base

, con

cret

e pa

vem

ent,

conc

rete

pav

emen

t and

ear

lyst

reng

th p

ortla

nd c

emen

t. T

his

is a

dai

ly re

capi

tula

tion

of q

uant

ities

and

is to

be

used

for e

stim

ate

purp

oses

.

This

pla

te m

ay b

e us

ed fo

r Bon

ded

Con

cret

e Pa

vem

ent,

Con

cret

e Bl

ock

Pave

men

t, C

oncr

ete

Bond

ed O

verla

y,C

oncr

ete

Bond

ed O

verla

y Pl

acem

ent O

nly,

Con

cret

e C

anal

Lin

ing,

Con

cret

e C

hann

el P

avin

g, C

oncr

ete

Shou

lder

,C

orru

gate

d C

oncr

ete

Div

ider

s, E

arly

Stre

ngth

Con

cret

e Pa

vem

ent,

Grin

ding

Con

cret

e Su

rface

, Rei

nfor

ced

Con

cret

eO

verla

y, R

ubbl

ized

Con

cret

e, C

oncr

ete

Plac

emen

t, an

d Br

idge

App

roac

h.

(*) T

hick

ness

(**)

Uni

form

or V

aria

ble

(***

) Uni

t of M

easu

re

501-2

(*)

(**)

CM

S(*

**)

(*

**)

(***

)

(***

)

Sam

ple

(*)

Acc

.(*)

Con

cret

e(*

)

(*)

Dat

eID

No.

Rep

.R

ecei

ved

Plac

edU

sed

O

n H

and

In

sp.

Rec

ap o

f tes

ted

mat

eria

l rec

eive

d an

d us

edTy

pe o

f Mat

eria

lR

ock/

Sand

Pro

duce

r:

Perc

ent o

f Mix

:

Loca

tion

Qua

lity

Lab

Sam

ple

ID N

o.

501

Rem

arks

NO

TE:

This

is a

fiel

d re

cord

of t

he a

ggre

gate

srec

eive

d, u

sed

and

on h

and.

Th

e qu

antit

ies

for p

repa

ratio

n of

the

"Tes

t Rep

ort"

can

be o

btai

ned

from

this

pla

te.

Sepa

rate

pla

te u

sed

for e

ach

mat

eria

l use

d on

pro

ject

.(*

) Gra

ding

of s

and:

FA-

A, S

SG-1

, etc

.(*

*) G

radi

ng o

f Roc

k: C

A-4

, CA

-5, e

tc.

(***

) Uni

t of m

easu

re: t

ons,

cu.

yds

., et

c.

1-1A

(*)

Acc

.(*)

(*

)A

cc.(*

)

Invo

ice

Bin

C

emen

tC

emen

t (*

*)C

emen

tC

emen

t

Dat

eN

umbe

rB

rand

Type

Num

ber

Rec

eive

dR

ecei

ved

Pou

red

Use

dO

n H

and

Rem

arks

Insp

.

501

REC

OR

D O

F C

ERTI

FIED

CEM

ENT

REC

EIVE

D A

ND

USE

D

(*)lb

s/kg

(**)

cu.

yds,

cu.

m, s

q/yd

s, s

q.m

, etc

.

NO

TE:

This

is a

fiel

d re

cord

of t

he c

emen

t rer

ecei

ved,

use

d an

d on

han

d. T

he d

istri

butio

n el

imin

ates

the

poss

ibilit

y of

pro

duci

ng c

oncr

ete

with

unt

este

d m

ater

ial.

The

qua

ntiti

es fo

r pre

para

tion

of th

e "T

est R

epor

t" ca

n be

obt

aine

d fro

m th

is p

late

.

1-1B

Kin

dW

eigh

tW

eigh

tW

eigh

tW

1A

ggr.

ofin

Air

in W

ater

in W

ater

Min

usSp

ecifi

c%

Sam

pled

Dat

eTi

me

Agg

rega

te(S

)(W

2)(W

1)W

2G

ravi

tyM

oist

ure

From

Rem

arks

Insp

.

501

REC

OR

D O

F M

OIS

TUR

E TE

STS

- (C

HEC

K T

ESTS

AT

CO

NC

RET

E PL

ANT)

The

oper

atio

nal c

heck

reco

rded

on

this

pla

te is

for v

erifi

catio

n of

the

moi

stur

e de

duct

ions

mad

e by

the

conc

rete

pro

duce

r.

1-1C

Dat

e

Tim

e

Stat

ion

Mea

s. W

t

Cor

r Fac

tor

Cor

rect

ed

CO

NC

RET

E TE

ST D

ATA

- CO

NC

RET

E PA

VEM

ENT

(*)(*

*)(A

E) L

ine

#

501-1D

Wei

ght

/Cu.

Ft.

Theo

. W

t. Pe

r Cu.

Ft.

Wt

Buc

ket,

Con

c &

G

lass

Wei

ght o

f B

ucke

t and

G

lass

YCF

Des

ign

YCF

% A

ir

Slum

p

Air T

emp

Mix

Des

ign

Insp

.

CM

S #

Rem

arks

(***

)

Wei

ght

Diff

eren

ce

Con

cret

e Te

mp

Bea

ms

or

Cyl

inde

rs

Plan

Act

ual

Plan

Act

ual

Dep

thD

epth

Supe

r

Dis

tanc

eD

epth

Dep

thW

idth

Wid

thW

ireC

.L.

Cro

wn

Dat

eTi

me

Stat

ion

C.L

.C

oncr

ete

Con

cret

eSl

abSl

abM

esh

Stee

lC

heck

Insp

.

501

CO

NC

RET

E - W

IDTH

, DEP

TH, S

TEEL

DEP

TH &

CR

OW

N IN

FOR

MAT

ION

1-1E

Dat

eD

efic

ienc

yIn

sp.

REC

OR

D O

F C

OR

ES T

AKEN

Prop

ortio

nal

Loca

tion

Dis

tanc

e to

C.L

.St

atio

nR

emar

ks

Part

of C

ontr

act

Pric

e A

llow

ed

50

Plan

Th

ickn

ess

Mea

sure

d Th

ickn

ess

1-1F

Acc

um.

Dat

eSi

deLi

n. F

t.Li

n. F

t.In

sp.

SEAL

ING

OF

PCC

P JO

INTS

Rem

arks

501

Sta.

to S

ta.

Loca

tion

Est

. No.

___

____

This

pla

te m

ay a

lso

be u

sed

for S

ealin

g of

PC

CP

Join

ts, S

ealin

g of

PC

CP

Cra

cks,

Sea

ling

PCC

P Jo

ints

,Se

alin

g Sp

alle

d PC

CP

Join

ts &

Cra

cks,

and

Sea

ling

PCC

P Jo

ints

& C

rack

s TY

A o

r B .

1-1G

Dat

eSi

deEa

chIn

sp.

Rec

ord

of T

ie B

ar In

sert

ion

Acc

um.

Each

Plan

Sp

acin

gM

easu

red

Spac

ing

Rem

arks

Loca

tion

Sta.

to S

ta.

501

This

pla

te m

ay a

lso

be u

sed

for D

owel

Bar

Ret

rofit

.

1-1H

Est

. No.

32+0

0

40+1

25,

100

x 24

=R

amp

9" U

nifo

rm9

43+1

212

'

13" U

nifo

rm

50

13,6

00 S

q, Y

ds.

Ram

p A

Area

468

Inte

rcha

nge

Sta.

40+

12 to

43+

12 &

43+

12 to

46+

12

SKET

CH

& C

OM

PUTA

TIO

NS

FOR

CO

NC

RET

E PA

VEM

ENT

Sta.

32+

00 to

Sta

. 83+

00

24' P

vmt.

5,10

0 Li

n. F

t.

24' W

idth

1.

08' D

epth

5,10

0' x

24'

x 1

.08'

=4,

896

Cu.

Yds

.27

46+1

250

Cu.

Yds

.27

100

Cu.

Yds

.83

+00

27

300'

x 6

' =20

0 S

q. Y

ds.

This

pla

te p

rese

nts

a sk

etch

and

com

puta

tions

of C

oncr

ete

9Pa

vem

ent o

r bas

ed p

lace

d ea

ch d

ay.

A su

mm

atio

n of

thes

e sq

uare

yard

s gi

ves

the

com

paris

on b

etw

een

plan

and

con

stru

cted

qua

ntity

300'

x 1

2' =

400

Sq. Y

ds.

whi

ch p

rovi

des

the

nece

ssar

y do

cum

enta

tion

to a

ccep

t pla

n qu

antit

y9

as th

e ba

sis

of fi

nal p

aym

ent.

The

squ

are

yard

s co

mpu

ted

each

day

Tota

l for

the

day

5,04

6 C

u. Y

ds.

is tr

ansf

erre

d to

pla

te N

o. V

-3 to

det

erm

ine

pay

estim

ate

quan

titie

s.To

tal f

or th

e da

y

14

,200

Sq.

Yds

.Pr

evio

us to

tal

10,2

00 S

q. Y

ds.

Tota

l to

date

24,4

00 S

q, Y

ds.

Com

pute

d by

: J.

D.

Che

cked

by:

J.M

.

(Avg

. Wid

th =

12'

)

300'

x 6

' x 0

.75'

=(A

vg. W

idth

= 6

')

300'

x 1

2' x

0.7

5' =

01-1I

Concrete Density Tests

Date LocationSideDist. CL

Reading 1Reading 2Reading 3

Avg.Corr. Fact.Corr. Read.

Standard

% of Stand.

Remarks

Insp.CMS #CMS #

501-1J

Line

#:

Plan

Qua

n:Lu

mp

Sum

Dat

eLa

neR

emar

ksIn

sp.

50

Rec

ord

of C

oncr

ete

Pave

men

t Sm

ooth

ness

Pave

men

t Se

ctio

n #

Spee

d Li

mit>

45

M.P

.H.

Ave

rage

Pro

. Ind

ex (i

n/m

ile)

Spee

d Li

mit<

= 45

M.P

.H.(p

lus

ram

ps)

03-1

Line

#:

Lum

p Su

m

Dat

eLa

neR

emar

ksIn

sp.

503

Rec

ap o

f Con

cret

e Pa

vem

ent S

moo

thne

ss

Pave

men

t Se

ctio

n #

Sta.

to S

ta.

Trac

e#1

Rou

ghne

ss

(inch

es)

Trac

e#1

Pro.

Inde

x (in

/mile

)

Trac

e#2

Rou

ghne

ss

(inch

es)

Trac

e#2

Pro.

Inde

x (in

/mile

)

Ave

rage

Pr

o. In

dex

(in/m

ile)

Plan

Qua

n:

3-1A

right

le

ft

Dat

eLa

neIn

sp.

503

Rem

arks

Rec

ap o

f Bum

p Lo

catio

ns

Dat

e C

orre

cted

Stat

ion

(R o

r L)

3-1B

Agg. Gradations (Type *)

DatePro. Code.Mtl. CodeSampled From*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)*( Sieve Screens)TonsType Insp.Results.InspCMS #

504-1

REA

DY

MIX

TR

UC

K IN

SPEC

TIO

N (

Rec

ord

truc

k da

ta, n

ot s

lum

ps u

nles

s ca

libra

ting

truc

ks)

Truc

k N

o.M

ake

Seria

l No.

Mfg

/Cap

Cu

Yd M

ixed

for T

estin

gTh

eo S

lum

pA

ctua

l Beg

inni

ng S

lum

pA

ctua

l Mid

poin

t Slu

mp

Act

ual E

nd o

f Loa

d Sl

ump

Dru

m C

ondi

tion

Wat

er T

ank

504-2

Wat

er V

alve

Rev

Cou

nter

Agi

tate

R.P

.M.

Mix

ing

Mfg

's P

late

Acc

epte

d R

emar

ks

Insp

2

CEM

ENT

SCA

LES

CH

ECK

Seria

l No.

Uni

t wei

ght i

n po

unds

(ki

logr

am)

Act

ual

Scal

ePe

rcen

tA

ccep

tW

eigh

tR

eadi

ngEr

ror

Rej

ect

Insp

.

Man

fact

urer

:

R

emar

ks

504-3

3

VIB

RA

TOR

CH

ECK

FO

R S

TRU

CTU

RES

AN

D B

RID

GE

DEC

KS

Hea

dA

vera

geR

adiu

s

Size

Am

plitu

deO

f Act

ion

Dat

e(In

ches

)(In

ches

)(In

ches

)R

emar

ksIn

sp

EA

CH

VIB

RA

TOR

SH

OU

LD B

E C

HE

CK

ED

AN

D R

EC

OR

DE

D.

Freq

uenc

y

Of V

ibra

tor

(Vib

ratio

ns /

Min

ute)

504-4

Vibr

ator

Seria

lN

umbe

r

4

TRU

CK

IDEN

TIFI

CA

TIO

N D

ATA

Truc

kLi

cens

eFu

elFu

elIn

itial

Dat

eN

o.Pl

ate

No.

Cap

acity

Type

Tare

Wt.

Insp

THIS

PLA

TE W

ILL

SE

RV

E A

S A

ME

AN

S O

F ID

EN

TIFY

ING

AN

D D

ES

CR

IBIN

G H

AU

L U

NIT

S.

THE

INFO

RM

ATI

ON

ON

FU

EL

TYP

E A

ND

CA

PA

CIT

Y A

ND

TH

E T

AR

E W

EIG

HT

IS O

F V

ALU

E O

NLY

ON

TH

OS

E H

AU

L U

NIT

S D

ELI

VE

RIN

G M

ATE

RIA

LO

N A

WE

IGH

T B

AS

IS.

FUE

L A

ND

TA

RE

WTS

. NO

T N

EE

DE

D F

OR

CO

NC

RE

TE H

AU

LIN

G.

Des

crip

tion

Rem

arks

504-55

8.43 17.25 Layout for a Level BookRANDOM OPERATION CHECKS for SLIPFORM PAVER (REQUIRED for MAINLINE PAVING)

Date TimeSta.V #1 freq.V #2 freq.V#3 freq.V #4 freq.V #5 freq.V #6 freq.V #7 freq.V #8 freq.Track Spd.Auto. Record On Y/N Insp.

Column Width: Row Height:

This plate is a record of the information obtained in the operational check of the slipform paver. Manufactures specification sheet should be submitted for each project.This check should be made at random times throughout the day to monitor paver operation. (See sec. 154.5 2007 Spec. Book for requirements.)

504-6