Form CEM-3501 "Hot Mix Asphalt Production Report" - California

What Is Form CEM-3501?

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 July 1, 2008;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-3501 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
Page 1 of 2
ADA Notice
HOT MIX ASPHALT PRODUCTION REPORT
For individuals with sensory disabilities, this document is available in alternate
CEM-3501 (REV 07/2008)
formats. For information, call (916) 445-1233, TTY 711, or write to Records
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Project Information
CONTRACT NUMBER
DATE
PLANT INSPECTOR
CO/RTE/PM
JMF NUMBER
CONTRACTOR
FOREMAN
BEGIN TIME
END TIME
Note: Use 24-hour clock throughout form
Producer
Plant Type
HMA
District
Batch
Mix type
Plant location
Batch/RAP
Producer's mix number
Production date
Continuous
Produced today
tons
Continuous/RAP
Estimated plant waste
tons
Total from aggregate totalizer
tons
MPQP accepted? (MPQP, Ch 1, II-C)
Yes
No Report Number
Expiration Date
Total from binder totalizer
tons
Security seals in place (MPQP, Ch 2, I-A)
Yes
No Explain:
Total from supplemental fines totalizer
tons
Type of release agent used (MPQP, Ch 2, II-A)
HMA batching tolerances (MPQP, Ch 2, II-G) Aggregate-
Binder-
HMA mixing (MPQP, Ch 2, I) Type-
Efficiency-
Certificate of compliance for asphalt binder
Date
certificate of compliance for LAS
Date
Asphalt Binder
Certificate of compliance for crumb rubber modifier
Date
Sampling time
Binder type
Certificate of compliance for asphalt modifier
Date
Sampling time
Binder type
Vehicle scale sealed?
Date
Sampling time
Binder type
Weighmaster's license?
Date
Sampler location (plant)
Total binder delivered to the plant today
tons
Ingredient Use
Aggregate Source
Aggregates
Target %
Actual %
Binders
Target %
Actual %
Aggregates
Source
SMARA No.
Temperature Log
Bin 1
Bin 1
Time
Bin 2
Bin 2
Binder°F
Bin 3
Bin 3
Agg/Mix°F
Bin 4
Bin 4
Supp Fine
Supp Fine
Sand Equivalent Test (CT 217)
LAS
Sand
Lime
Clay
Rubber
Rubber
Sand equivalent
Sampling time
Time
Remarks
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 1 of 2
ADA Notice
HOT MIX ASPHALT PRODUCTION REPORT
For individuals with sensory disabilities, this document is available in alternate
CEM-3501 (REV 07/2008)
formats. For information, call (916) 445-1233, TTY 711, or write to Records
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Project Information
CONTRACT NUMBER
DATE
PLANT INSPECTOR
CO/RTE/PM
JMF NUMBER
CONTRACTOR
FOREMAN
BEGIN TIME
END TIME
Note: Use 24-hour clock throughout form
Producer
Plant Type
HMA
District
Batch
Mix type
Plant location
Batch/RAP
Producer's mix number
Production date
Continuous
Produced today
tons
Continuous/RAP
Estimated plant waste
tons
Total from aggregate totalizer
tons
MPQP accepted? (MPQP, Ch 1, II-C)
Yes
No Report Number
Expiration Date
Total from binder totalizer
tons
Security seals in place (MPQP, Ch 2, I-A)
Yes
No Explain:
Total from supplemental fines totalizer
tons
Type of release agent used (MPQP, Ch 2, II-A)
HMA batching tolerances (MPQP, Ch 2, II-G) Aggregate-
Binder-
HMA mixing (MPQP, Ch 2, I) Type-
Efficiency-
Certificate of compliance for asphalt binder
Date
certificate of compliance for LAS
Date
Asphalt Binder
Certificate of compliance for crumb rubber modifier
Date
Sampling time
Binder type
Certificate of compliance for asphalt modifier
Date
Sampling time
Binder type
Vehicle scale sealed?
Date
Sampling time
Binder type
Weighmaster's license?
Date
Sampler location (plant)
Total binder delivered to the plant today
tons
Ingredient Use
Aggregate Source
Aggregates
Target %
Actual %
Binders
Target %
Actual %
Aggregates
Source
SMARA No.
Temperature Log
Bin 1
Bin 1
Time
Bin 2
Bin 2
Binder°F
Bin 3
Bin 3
Agg/Mix°F
Bin 4
Bin 4
Supp Fine
Supp Fine
Sand Equivalent Test (CT 217)
LAS
Sand
Lime
Clay
Rubber
Rubber
Sand equivalent
Sampling time
Time
Remarks
Sampled by
Grading by
HOT MIX ASPHALT
Page 2 of 2
Sampling date
Sampling time
Tons mix out at sample
PRODUCTION REPORT (continued)
Sampling location
Sample moisture
percent
CEM-3501 (REV. 07/2008)
EA
Grading
of
for this shift and this plant
Combined Grading Results, HMA Batch
Bin Number 4
Bin Number 3
Bin Number 2
Bin Number 1
Supplemental Fines
Total
Agg. Description
Agg. Description
Agg.Description
Agg. Description
Agg. Description
Bin %
Bin Use
Sample Weight
Bin Use
Sample Weight
Bin Use
Sample Weight
Bin Use
Sample Weight
Bin Use
Sample Weight
%
grams
%
grams
%
grams
%
grams
%
grams
Weight
%
%
Weight
%
%
%
Weight
%
%
%
Weight
%
%
%
Weight
%
%
%
Combined
%
Retain
Retain
Pass
Used
Retain
Retain
Pass
Used
Retain
Retain
Pass
Used
Retain
Retain
Pass
Used
Retain
Retain
Pass
Used
Grading
Sieve Size
2"
½"
1
1"
¾"
½"
⅜"
No. 4
No. 8
No. 16
No. 30
No. 50
No. 100
No. 200
Combined Grading Results, HMA Continuous
RAP Grading - HMA
Supp. Fine Grading - HMA Continuous
Plus number 4 material
Minus number 4 material
RAP
Supplemental Fines
Sample Weight
Sample Weight
Sample Weight
Sample Weight
Weight
%
%
Weight
%
%
Combined
Weight
%
%
Weight
%
%
Retain
Retain
Pass
Retain
Retain
Pass
Grading
Retain
Retain
Pass
Retain
Retain
Pass
Sieve Size
Sieve Size
Sieve Size
2"
2"
½"
½"
1
1
1"
1"
¾"
¾"
½"
½"
⅜"
⅜"
No. 4
No. 4
No. 8
No. 8
No. 8
No. 16
No. 16
No. 16
No. 30
No. 30
No. 30
No. 50
No. 50
No. 50
No. 100
No. 100
No. 100
No. 200
No. 200
No. 200
Time
Remarks
Page of 2