Materials Certification Project Compliance Summary Check-List
SP or SAP #
Resident Engineer:
District #
Number of Boxes submitted:
Construction Office Location:
Below is a Check List with the required documents for the yearly compliance summary.
Please complete this list and submit your materials to
Carol Starbuck, Maplewood Materials Lab – MS645
Technical Requirements and Questions should be directed to
Curt Turgeon, Pavement Engineer @ 651-366-5535
General Documents
Plans
Proposal
Final Estimate
Materials Certification Exceptions Summary (2171)
Change Orders – All (21840)
Supplemental Agreements
Work Orders
Materials Certification Project Compliance Summary Check-List
SP or SAP #
Resident Engineer:
District #
Number of Boxes submitted:
Construction Office Location:
Concrete Related Documents
Paving Documents
Paving Contact Report (2164)
Request For Concrete Mix Approval
JMF Submittal Worksheet
Cement Record (2157)
Agency Concrete Aggregate Worksheet-JMF
Contractor Concrete Aggregate Worksheet-JMF
Sand Patch Test Results
Concrete Batching Report (2152)
Weekly Concrete Report (2448)
Concrete Test Beam Data (2162)
Field Core Report (24327)
Test Reports on Concrete Pavement Cores (24324)
Materials Certification Project Compliance Summary Check-List
SP or SAP #
Resident Engineer:
District #
Number of Boxes submitted:
Construction Office Location:
Paving Documents When Required
Contractor Control Charts:
Aggregate Moisture Content
W/C Ratio Quality Control
Total Water in Mix
Composite Gradation (Well-Graded Aggregate)
Air Content
Flexural Strength
Concrete W/C Ratio Calculation (Microwave Oven) Worksheet
Concrete Ride Profile Summary
Well-graded Aggregate Summary Sheet
W/C Ratio Incentive / Disincentive Summary Sheet
Concrete Aggregate Quality Incentive / Disincentive
Lab Reports for Paving
Aggregate Quality Report (LIMS)
Concrete Cylinder Test Reports (LIMS)
Test Report on Cement Sample (LIMS)
Test Report on Fly Ash Sample (LIMS)
Test Report on Slag Sample (LIMS)
Test Report on Admixtures (LIMS)
Test Report on Curing Compound (LIMS)
Test Report on Dowel Bars or Certification (LIMS)
Test Report on Joint Materials (LIMS)
Materials Certification Project Compliance Summary Check-List
SP or SAP #
Resident Engineer:
District #
Number of Boxes submitted:
Construction Office Location:
Concrete Ready-Mix Document
Contact Report (2163)
Concrete Mix Design (2416 / 2406)
Weekly Concrete Reports (2448)
Weekly Concrete Ready-Mix Plant Reports (24143)
Weekly Concrete Aggregate Reports (2449)
Diaries
Certificates of Compliance (#0042 / Contractor)
Lab Reports for Ready-Mix
Aggregate Quality Reports (LIMS)
Concrete Cylinder Test Reports (LIMS)
Test Report on Fly Ash Sample (LIMS)
Test Report on Cement Sample (LIMS)
Test Report on Admixtures (LIMS)
Materials Certification Project Compliance Summary Check-List
SP or SAP #
Resident Engineer:
District #
Number of Boxes submitted:
Construction Office Location:
Concrete Low-Slump Overlay Documents
Lab Reports of Aggregate Gradation (LIMS)
Weekly Report of Low-Slump Concrete (21412)
Concrete Cylinder Test Reports (LIMS)
Materials Certification Project Compliance Summary Check-List
SP or SAP #
Resident Engineer:
District #
Number of Boxes submitted:
Construction Office Location:
Bituminous Documents
Test Summary Sheet
Core Density Worksheets
Core Density Incentive / Disincentive – Summary Spreadsheets
Ride Quality Profile Tapes
Ride Quality Incentive / Disincentive – Summary Spreadsheets
Plant Certification
MDRs (Mix Design Reports)
Asphalt Cement Bills of Lading
Materials Certification Project Compliance Summary Check-List
SP or SAP #
Resident Engineer:
District #
Number of Boxes submitted:
Construction Office Location:
Grading and Base Documents
All Grading & Base Reports
Grading & Base Test Results
Grading & Base Summary Forms:
Lab Companion Test Results
Independent Assurance Tests & Reports
Secondary Acceptance Documentation:
Form# 2415
Form# 2403
Letters To File
Certification Forms – Aggregates
All Recommendations from Specialty Office