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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
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ngth
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cret
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cret
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rface
, Rei
nfor
ced
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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
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r
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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