NONCOMPLYING TESTS OR MEASUREMENTS OF

MATERIAL INCORPORATED INTO THE PROJECT

 

Project No.:

 

County:

 

 

 

 

 

Contractor:

 

Type of Work:

 

 

 

 

 

General information as to type of test, results, and other available data that may be pertinent

Quantity Involved

Action Taken

 

 

 

 

Noncomplying Field Lab Line number _________

one lab

See letter from XXXXXX (dated) and EWO # ______ for $ZZZ.ZZ

 

Violation of Article 1105.12B and D. Moved sheepsfoot roller on AC-surfaced roadway causing mars and distortions

Monetary deduct

See letter from XXXXXX (dated) and EWO # ______ for $Z,ZZZ.ZZ

 

 

 

 

Low Air Content 3.8%

Required 6.5% + 1.5%

7 m3 (yd3)

5 m3 (yd3) placed before air percent is known. Contractor advised, but placed the last 2 m3 (yd3) anyway. 7 m3 (yd3) less than 3% of total quantity, but 100% adjustment on the last 2 m3 (yd3) = $ZZZ,ZZZ. See letter from XXXXXXX.

 

 

 

 

Thin Concrete Bands 2 and 3

1733 m3 (yd3)

Item 8005 - $Z,ZZZ.ZZ See EWO # ______

 

 

 

 

Job Mix Gradation 4.75 mm (#4) Sieve 78% Required 70% + 7%

10,000 Mg (tons)

No adjustment. See attached letter from XXXXXX XXXX.

 

 

TOTAL Amount Entered on Form 830436  $Z,ZZZ.ZZ

 

By _________________________________

(Project Engineer)

 

Date ________________________________