Form CEM-3513 "Caltrans Hot Mix Asphalt Verification" - California

What Is Form CEM-3513?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the California Department of Transportation;
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  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-3513 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CALTRANS HOT MIX ASPHALT VERIFICATION
Page 1 of 9
CEM-3513 (REV 05/2019)
HMA PRODUCER NAME AND ADDRESS
JMF VERIFICATION PERFORMED FOR
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
HMA PLANT ADDRESS
PROJECT INFORMATION/NAME
PRODUCER CONTACT
PHONE NUMBER
RESIDENT ENGINEER
PHONE NUMBER
JOB MIX FORMULA (JMF) INFORMATION
Hot Mix Asphalt (HMA) Type/Grading
Grade of Asphalt Binder
Asphalt Binder Content Target Value Percentage
Producer Mix Identification Number
Antistrip Type
Antistrip Percentage
Asphalt Rubber Binder Producer Name and Address WMA Technology Product Name
WMA Additive Percentage
Reclaimed Asphalt Pavement (RAP) Source
RAP Percentage
Asphalt Rubber Binder Producer Phone Number Aggregate Sources
Page 3 of CEM-3511 attached to document aggregate sources.
JMF VERIFICATION SAMPLING INFORMATION
Location hot mix asphalt verification samples taken
Date samples taken
HMA samples taken by (print name)
HMA sampling witnessed by (print name)
Materials samples taken by (print name)
Materials sampling witnessed by (print name)
Materials Samples
Yes
No
Samples taken under California Test 125 in the Engineer's presence?
Aggregate
Supplemental Fines
Reclaimed Asphalt Pavement (RAP)
High Natural CRM
Antistrip
Asphalt Binder
Asphalt Rubber Binder
Warm Mix Asphalt Additive
Scrap Tire CRM
VERIFICATION
Is JMF verification based on adjusted target values?
Yes
No
(If yes, attach CEM-3511 page 4 to this form to document JMF adjustments)
HMA complies with the specifications?
Hot mix asphalt (page 7)?
Combined aggregate grading (page 2)?
Yes
No
Yes
No
Hot mix asphalt (page 8)?
Aggregate quality (page 3)?
Yes
No
Yes
No
JMF Lab accreditation verified?
Aggregate quality (page 4)?
Yes
No
Yes
No
Lab Personnel certifications verified?
Crumb Rubber and Asphalt Modifier (page 5)?
Yes
No
N/A
Yes
No
Asphalt Binder and Asphalt Rubber Binder (page 6)?
Yes
No
N/A
If yes to all of the above, then HMA complies with the specifications and the HMA mix is verified.
If no to any question above then immediately notify the resident engineer.
Accepted verification by (print name and sign)
Title
Date
Failed verification by (print name and sign)
Title
Date
Resident engineer notified of HMA verification results by (print name and sign)
Date
Contractor notified of verification or failed verification by (print name and sign)
Date
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CALTRANS HOT MIX ASPHALT VERIFICATION
Page 1 of 9
CEM-3513 (REV 05/2019)
HMA PRODUCER NAME AND ADDRESS
JMF VERIFICATION PERFORMED FOR
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
HMA PLANT ADDRESS
PROJECT INFORMATION/NAME
PRODUCER CONTACT
PHONE NUMBER
RESIDENT ENGINEER
PHONE NUMBER
JOB MIX FORMULA (JMF) INFORMATION
Hot Mix Asphalt (HMA) Type/Grading
Grade of Asphalt Binder
Asphalt Binder Content Target Value Percentage
Producer Mix Identification Number
Antistrip Type
Antistrip Percentage
Asphalt Rubber Binder Producer Name and Address WMA Technology Product Name
WMA Additive Percentage
Reclaimed Asphalt Pavement (RAP) Source
RAP Percentage
Asphalt Rubber Binder Producer Phone Number Aggregate Sources
Page 3 of CEM-3511 attached to document aggregate sources.
JMF VERIFICATION SAMPLING INFORMATION
Location hot mix asphalt verification samples taken
Date samples taken
HMA samples taken by (print name)
HMA sampling witnessed by (print name)
Materials samples taken by (print name)
Materials sampling witnessed by (print name)
Materials Samples
Yes
No
Samples taken under California Test 125 in the Engineer's presence?
Aggregate
Supplemental Fines
Reclaimed Asphalt Pavement (RAP)
High Natural CRM
Antistrip
Asphalt Binder
Asphalt Rubber Binder
Warm Mix Asphalt Additive
Scrap Tire CRM
VERIFICATION
Is JMF verification based on adjusted target values?
Yes
No
(If yes, attach CEM-3511 page 4 to this form to document JMF adjustments)
HMA complies with the specifications?
Hot mix asphalt (page 7)?
Combined aggregate grading (page 2)?
Yes
No
Yes
No
Hot mix asphalt (page 8)?
Aggregate quality (page 3)?
Yes
No
Yes
No
JMF Lab accreditation verified?
Aggregate quality (page 4)?
Yes
No
Yes
No
Lab Personnel certifications verified?
Crumb Rubber and Asphalt Modifier (page 5)?
Yes
No
N/A
Yes
No
Asphalt Binder and Asphalt Rubber Binder (page 6)?
Yes
No
N/A
If yes to all of the above, then HMA complies with the specifications and the HMA mix is verified.
If no to any question above then immediately notify the resident engineer.
Accepted verification by (print name and sign)
Title
Date
Failed verification by (print name and sign)
Title
Date
Resident engineer notified of HMA verification results by (print name and sign)
Date
Contractor notified of verification or failed verification by (print name and sign)
Date
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CALTRANS HOT MIX ASPHALT VERIFICATION
Page 2 of 9
CEM-3513 (REV 05/2019)
HMA TYPE/GRADING
PRODUCER NAME
PRODUCER MIX IDENTIFICATION NUMBER
VERIFICATION SAMPLE DATE
DATE
COMBINED AGGREGATE GRADATION (See Notes 1 & 2)
RAP
Meets
RAP
Job Mix Formula
Requirement
Virgin Aggregate
Aggregate Gradation
Corrected RAP
Specification?
Gradation Correlation
Combined
Target Value from
Specification Limits
Split Sample
Gradation
Recovered from
Gradation
Factor from
Gradation
CEM-3512
(Target Value ±
% of Blend
AASHTO T308
% of Blend
Yes
No
CEM-3512
(See Note 3)
Tolerance
)
(Method A)
Sieve Size
% Passing
2"
1½"
1"
¾"
½"
⅜"
No. 4
No. 8
No. 16
No. 30
No. 50
No. 100
No. 200
Yes
No
RAP asphalt
Adjusted target
binder content
value?
Notes
1) For RHMA-G-SP show aggregate gradation under combined gradation and verify compliance with specifications.
2) When determining the combined virgin and reclaimed asphalt material RAP aggregate gradation, burn off the RAP sample in accordance with AASHTO T308 (Method A). Report the
asphalt content of the RAP sample for information purposes. Perform a sieve analysis on recovered aggregate in accordance with AASHTO T30. Add the correlation factor Form
CEM-3512, "Contractor Hot Mix Asphalt Design Data". Mathematically combine the virgin and corrected RAP aggregate gradations at the correct proportions to obtain the combined
gradation.
3) For a JMF with adjusted aggregate target values attach Form CEM-3511, "Contractor Job Mix Formula Proposal" page 4 to this verification form.
Notes
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CALTRANS HOT MIX ASPHALT VERIFICATION
Page 3 of 9
CEM-3513 (REV 05/2019)
HMA TYPE/GRADING
PRODUCER NAME
DATE
PRODUCER MIX IDENTIFICATION NUMBER
VERIFICATION SAMPLE DATE
AGGREGATE QUALITY (See Note)
Requirement
Meet
Specification?
HMA Type
Quality Characteristic/Property
Test Method
Test Result
Type A
RHMA-G
Yes
No
Crushed particles, coarse
AASHTOT T 335
aggregate
95
Method 2
One fractured face (%, min)
Crushed particles, coarse
AASHTOT T 335
aggregate
90
90
Method 2
Two fractured faces (%, min)
Crushed particles, fine aggregate
(Passing No. 4 sieve and retained on
AASHTOT T 335
70
90
No. 8 sieve)
Method 2
One fractured face (%, min)
Los Angeles Rattler, Loss at 100
AASHTO T 96
12
12
Rev. (%, max)
Los Angeles Rattler, Loss at 500
AASHTO T 96
40
40
Rev. (%, max)
Sand equivalent (min)
AASHTO T 176
47
47
AASHTO T 304
Fine aggregate angularity (%)
45
45
Method A
Flat and elongated particles
(% by mass at 5:1)
ASTM D 4791
10
10
¼" thru ¾" grading
1" grading
Plasticity Index (max)
California Test 204
10
10
Note
Aggregate must comply with the quality specifications before it is treated with lime.
Notes
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CALTRANS HOT MIX ASPHALT VERIFICATION
Page 4 of 9
CEM-3513 (REV 05/2019)
HMA TYPE/GRADING
PRODUCER NAME
DATE
PRODUCER MIX IDENTIFICATION NUMBER
VERIFICATION SAMPLE DATE
AGGREGATE QUALITY (Continued)
Requirement
Meet
Specification?
HMA Type
Quality Characteristic/Property
Test Method
Test Result
Type A
RHMA-G
Yes
No
Bulk specific gravity (oven dry) of coarse
Report
Report
AASHTO T 85
aggregate
only
only
Report
Report
Absorption of coarse aggregate
AASHTO T 85
only
only
Bulk specific gravity (SSD) of fine
Report
Report
AASHTO T 84
aggregate
only
only
Report
Report
Bulk specific gravity of fine aggregate
AASHTO T 84
only
only
Report
Report
Apparent specific gravity of fine aggregate
AASHTO T 84
only
only
Apparent specific gravity of supplemental
Report
Report
AASHTO T 84
fines
only
only
Report
Report
Absorption of fine aggregate
AASHTO T 84
only
only
MS-2
Bulk specific gravity of the virgin
Report
Report
Asphalt Mixtures
aggregate blend
only
only
(See Note)
MS-2
Report
Report
Effective specific gravity of coarse RAP
Asphalt Mixtures
only
only
(See Note)
MS-2
Report
Report
Effective specific gravity of fine RAP
Asphalt Mixtures
only
only
(See Note)
MS-2
Effective combined specific gravity of
Report
Report
Asphalt Mixtures
RAP
only
only
(See Note)
MS-2
Bulk specific gravity of the virgin RAP
Report
Report
Asphalt Mixtures
aggregate blend
only
only
(See Note)
NON-STANDARD SPECIAL PROVISION SPECIFIED QUALITY CHARACTERISTICS
Sodium sulfate soundness
AASHTO T 104
California Test
Cleanness Value
227
Fine aggregate
AASHTO T 210
Durability Index
Coarse aggregate
AASHTO T 210
Durability Index
Note
th
See MS-2 Asphalt Mix Design Methods. 7
Edition, by the Asphalt Institute.
Notes
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CALTRANS HOT MIX ASPHALT VERIFICATION
Page 5 of 9
CEM-3513 (REV 05/2019)
HMA TYPE/GRADING
PRODUCER NAME
DATE
PRODUCER MIX IDENTIFICATION NUMBER
VERIFICATION SAMPLE DATE
Sample asphalt binder for verification and submit samples to METS for testing.
Submit HMA verification results to the contractor when aggregate and HMA testing is completed, do not wait for asphalt binder test results.
CRUMB RUBBER MODIFIER (See Note)
Crumb Rubber modifier samples submitted to METS
Date samples shipped to METS for testing
Yes
No
for testing?
Meet
Test Result
Specification?
Quality Characteristic/Property
Test Method
Requirement
Yes
No
Scrap Tire
High Natural
Scrap Tire CRM gradation
California Test
100
(% passing No. 8 sieve)
385
High natural CRM gradation
California Test
100
(% passing No. 10 sieve)
385
California Test
Wire in CRM (% max.)
0.01
385
California Test
Fabric in CRM (% max.)
0.05
385
CRM particle length (inch max.)
3/16
-
CRM specific gravity
California Test 208
1.1 — 1.2
Natural rubber content in high natural
ASTM D 297
40.0 — 48.0
CRM (%)
ASPHALT MODIFIER (See Note)
Date samples shipped to METS for testing
Asphalt modifier sample submitted to METS for testing?
Yes
No
Meet
Specification?
Quality Characteristic/Property
Test Method
Test Result
Requirement
Yes
No
Viscosity at 100°C, (m 2 /s (x10 -6 ))
ASTM D 445
19 to 36 (±3)
Flash Point, Cleveland Open Cup,
ASTM D 92
207
(°C min)
Molecular analysis
ASTM D 2007
0.1
Asphaltenes, (percent by mass max)
Molecular analysis
ASTM D 2007
55
Aromatics, (percent by mass min)
Note
Must be provided with a certificate of compliance with testing performed by an AASHTO certified laboratory.
Notes
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.