Form CEM-3802 "Quality Control Inspector Affidavit of Proficiency" - California

What Is Form CEM-3802?

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 February 1, 2009;
  • 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-3802 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-3802 "Quality Control Inspector Affidavit of Proficiency" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
QUALITY CONTROL INSPECTOR AFFIDAVIT of PROFICIENCY
CEM-3802 (NEW 02/2009)
CONTRACTOR NAME, ADDRESS, AND PHONE NUMBER
CONTRACT NUMBER/CO/RTE/PM
PROJECT INFORMATION/NAME
Instructions: This form is used for all quality control inspection personnel, plant, and placement.
In accordance with the requirements of the Quality Control Manual for Hot Mix Asphalt, submitted for your approval is the following
Hot Mix Asphalt (HMA) inspector.
Name
Employer
Summary of HMA related construction inspection experience and training. Be specific. (attach full resume)
I have reviewed this inspector's qualifications and am satisfied that this inspector meets or exceeds the requirements for this
contract. This inspector is fully aware of the required duties and responsibilities.
Quality Control Manager:
Date:
(Signature)
ADA Notice
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
QUALITY CONTROL INSPECTOR AFFIDAVIT of PROFICIENCY
CEM-3802 (NEW 02/2009)
CONTRACTOR NAME, ADDRESS, AND PHONE NUMBER
CONTRACT NUMBER/CO/RTE/PM
PROJECT INFORMATION/NAME
Instructions: This form is used for all quality control inspection personnel, plant, and placement.
In accordance with the requirements of the Quality Control Manual for Hot Mix Asphalt, submitted for your approval is the following
Hot Mix Asphalt (HMA) inspector.
Name
Employer
Summary of HMA related construction inspection experience and training. Be specific. (attach full resume)
I have reviewed this inspector's qualifications and am satisfied that this inspector meets or exceeds the requirements for this
contract. This inspector is fully aware of the required duties and responsibilities.
Quality Control Manager:
Date:
(Signature)
ADA Notice
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.