Form CEM-3736AC "Asphalt Concrete Pavement Smoothness Corrections Information" - California

What Is Form CEM-3736AC?

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 September 1, 2017;
  • 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-3736AC 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-3736AC "Asphalt Concrete Pavement Smoothness Corrections Information" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
ASPHALT CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
Page 1 of 5
CEM-3736AC (REV 09/2017)
PROJECT INFORMATION/NAME
CONTRACT NUMBER
CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CONTRACTOR NAME
Instructions: Use this form to provide information on pavement smoothness corrections. The information collected on this form will be used by
Caltrans to compare inertial profile data collected from existing pavement through final surface after corrections to evaluate the pavement
smoothness specifications. Providing the raw data file with specified naming requirements will assist in the analysis. For questions about this
form send an email to:
smoothness@dot.ca.gov.
GENERAL PROJECT INFORMATION
Location
Lane Number
Direction
Date
Beginning Station/Post Mile
Ending Station/Post Mile
Inertial Profiler Operator Name
Inertial Profiler Operator Email
Inertial Profiler Operator Phone Number
ProVAL Analysis by Name
ProVAL Analysis by Email
ProVAL Analysis by Phone Number
PAVEMENT SMOOTHNESS INERTIAL PROFILE INFORMATION (Check all that apply)
Prepaving Existing Asphalt Concrete
Raw Profile Data File Name (*.ppf or *.pvp)
Prepaving existing asphalt concrete pavement
Raw Profile Data File Name (*.ppf or *.pvp)
Prepaving post corrections
Hot Mix Asphalt
Raw Profile Data File Name (*.ppf or *.pvp)
Post paving before corrections
Raw Profile Data File Name (*.ppf or *.pvp)
Final post paving after corrections
Open Graded Friction Course
Raw Profile Data File Name (*.ppf or *.pvp)
Post paving OGFC surface before corrections
Raw Profile Data File Name (*.ppf or *.pvp)
Final post paving after corrections
Cold Planing
Raw Profile Data File Name (*.ppf or *.pvp)
Existing pavement before cold planing
Raw Profile Data File Name (*.ppf or *.pvp)
Cold planed surface
Seal Coat
Raw Profile Data File Name (*.ppf or *.pvp)
Existing pavement before seal coat
Raw Profile Data File Name (*.ppf or *.pvp)
Seal coat surface
Cold In-place Recycling
Raw Profile Data File Name (*.ppf or *.pvp)
Existing pavement before cold in-place recycling
Raw Profile Data File Name (*.ppf or *.pvp)
Cold in-place recycling surface before corrections
Raw Profile Data File Name (*.ppf or *.pvp)
Final cold in-place recycling surface after corrections
Comments:
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
ASPHALT CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
Page 1 of 5
CEM-3736AC (REV 09/2017)
PROJECT INFORMATION/NAME
CONTRACT NUMBER
CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CONTRACTOR NAME
Instructions: Use this form to provide information on pavement smoothness corrections. The information collected on this form will be used by
Caltrans to compare inertial profile data collected from existing pavement through final surface after corrections to evaluate the pavement
smoothness specifications. Providing the raw data file with specified naming requirements will assist in the analysis. For questions about this
form send an email to:
smoothness@dot.ca.gov.
GENERAL PROJECT INFORMATION
Location
Lane Number
Direction
Date
Beginning Station/Post Mile
Ending Station/Post Mile
Inertial Profiler Operator Name
Inertial Profiler Operator Email
Inertial Profiler Operator Phone Number
ProVAL Analysis by Name
ProVAL Analysis by Email
ProVAL Analysis by Phone Number
PAVEMENT SMOOTHNESS INERTIAL PROFILE INFORMATION (Check all that apply)
Prepaving Existing Asphalt Concrete
Raw Profile Data File Name (*.ppf or *.pvp)
Prepaving existing asphalt concrete pavement
Raw Profile Data File Name (*.ppf or *.pvp)
Prepaving post corrections
Hot Mix Asphalt
Raw Profile Data File Name (*.ppf or *.pvp)
Post paving before corrections
Raw Profile Data File Name (*.ppf or *.pvp)
Final post paving after corrections
Open Graded Friction Course
Raw Profile Data File Name (*.ppf or *.pvp)
Post paving OGFC surface before corrections
Raw Profile Data File Name (*.ppf or *.pvp)
Final post paving after corrections
Cold Planing
Raw Profile Data File Name (*.ppf or *.pvp)
Existing pavement before cold planing
Raw Profile Data File Name (*.ppf or *.pvp)
Cold planed surface
Seal Coat
Raw Profile Data File Name (*.ppf or *.pvp)
Existing pavement before seal coat
Raw Profile Data File Name (*.ppf or *.pvp)
Seal coat surface
Cold In-place Recycling
Raw Profile Data File Name (*.ppf or *.pvp)
Existing pavement before cold in-place recycling
Raw Profile Data File Name (*.ppf or *.pvp)
Cold in-place recycling surface before corrections
Raw Profile Data File Name (*.ppf or *.pvp)
Final cold in-place recycling surface after corrections
Comments:
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
ASPHALT CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
Page 2 of 5
CEM-3736AC (REV 09/2017)
PAVING INFORMATION (Check all that apply)
Paving Information
foot
Hot mix asphalt lift thickness:
Hot mix asphalt was placed in windrow
Windrow elevator was used to deposit hot mix asphalt into paver hopper
Windrow elevator was used to deposit cold in-place recycled material into paver hopper
End dumps deposited hot mix asphalt into paver hopper
Material transfer vehicle used
Paver Automatic Controls
Automatic paver controls were not used
feet
Length of contact ski or sonar device used:
Contact ski device
One side
Both sides
Sonar device
Two points
Three points
One side
Both sides
For contact ski device and sonar device when used on only one side was the other side controlled by?:
Joint matcher
Automatic cross slope control
Manual adjustment
Joint matcher and automatic cross slope control
Joint matcher both sides
String or wire line
One side
Both sides
For string or wire line when used on only one side was the other side controlled by?
Joint matcher
Automatic cross slope control
Automatic Machine Guidance
Was the ski device, sonar device, or joint matcher used on a previously corrected surface?
Yes
No
Comments:
COLD PLANING INFORMATION (Check all that apply)
Cold plane thickness:
foot
Constant depth of cold planing
Variable depth of cold planing
Micro mill cutting head
Automatic Controls
Automatic Controls were not used
feet
Length of contact ski or sonar device used:
Contact ski device
One side
Both sides
Sonar device
Two points
Three points
One side
Both sides
For contact ski device and sonar device when used on only one side was the other side controlled by?
Joint matcher
Automatic cross slope control
Manual adjustment
Joint matcher and automatic cross slope control
Joint matcher both sides
One side
Both sides
String or wire line
For string or wire line when used on only one side was the other side controlled by?
Joint matcher
Automatic cross slope control
Automatic Machine Guidance
Was the ski device, sonar device, or joint matcher used on a previously corrected surface?
Yes
No
Comments:
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
ASPHALT CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
Page 3 of 5
CEM-3736AC (REV 09/2017)
PREPAVING GRINDING CORRECTIONS INFORMATION
Type of Grinder Used:
Areas of Localized Roughness
Grinding required to meet areas of localized
Were there areas of localized roughness that
Grinding Information
roughness?
could not be corrected by grinding?
18 foot wheelbase
Yes
No
Yes
No
25 foot wheelbase
Custom Grinder (see below)
Total number of areas of localized roughness
Areas of localized roughness corrected to:
Custom Grinder Information
N/A
that could not be corrected by grinding:
180 in/mile
Grinder wheel base
feet
number of locations
Other:
in/mile
Maximum grinding depth
inch
Number of grind locations required to meet
Were there areas of localized roughness
Head position
Lf/L
areas of localized roughness:
corrected by other methods?
Tandem spread
feet
Left wheel path number of grind
Yes
No
Short cutoff wavelength
locations
feet
Method of correction used:
Right wheel path number of grind
locations
Hot mix asphalt leveling
Linear feet of grinding required to meet areas
Grind Location Determination:
Remove and replace surfacing
Grind locations were determined using ProVAL
of localized roughness requirement:
Other
smoothness assurance grind modeling?
Left wheel path linear feet
If other, describe method under comments.
Yes
No
Right wheel path linear feet
If no, describe method used to determine
smoothness correction locations in comments
section.
Number of grinding hours required to meet
Grinding Corrections:
area of localized roughness requirements
Wheel path (3 foot)
Other
hours
6 foot (half lane width)
12 foot (full lane width)
If there were areas of localized roughness that could not be corrected by grinding or other
Method of Locating Grind Locations:
methods, describe the situation and why grinding or other methods would not work to correct
Inertial Profiler Distance Measuring
smoothness in comments section.
Instrument
GPS Coordinates
Accuracy of GPS Devise
Offset Distance from Semi-Permanent
Reference Points
Other Method
If other method, describe method in comments
section.
Comments:
Email
Report Completed by (Print name)
Phone Number
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
ASPHALT CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
Page 4 of 5
CEM-3736AC (REV 09/2017)
CORRECTIVE GRINDING INFORMATION
Grinding Information
Areas of Localized Roughness
Mean Roughness Index
Grinding required to meet areas of localized
Grinding required to meet mean roughness
Type of Grinder Used:
roughness?
index?
18 foot wheelbase
Yes
No
Yes
No
25 foot wheelbase
Areas of localized roughness smoothness
Mean roughness index smoothness assurance
assurance report analysis based on:
report analysis based on:
Custom Grinder (see below)
120 in/mile
160 in/mile
60 in/mile
75 in/mile
Custom Grinder Information
N/A
180 in/mile
Other:
in/mile
Other:
in/mile
feet
Grinder wheel base
Number of grind locations required to meet
Number of grind locations required to meet
areas of localized roughness:
mean roughness index:
inch
Maximum grinding depth
Left wheel path number of grind
Left wheel path number of grind
Lf/L
Head position
locations
locations
feet
Tandem spread
Right wheel path number of grind
Right wheel path number of grind
Short cutoff wavelength
feet
locations
locations
Linear feet of grinding required to meet areas
Linear feet of grinding required to meet mean
Grind Location Determination:
of localized roughness requirement:
roughness index:
Grind locations were determined using ProVAL
Left wheel path linear feet
Left wheel path linear feet
smoothness assurance grind modeling?
Right wheel path linear feet
Right wheel path linear feet
Yes
No
Number of grinding hours required to meet
Number of grinding hours required to meet
If no, describe method used to determine
area of localized roughness requirements
mean roughness index requirements
smoothness correction locations in comments
section.
hours
hours
Grinding Corrections:
If there were areas of localized roughness that
If there were mean roughness index segments
Wheel path (3 foot)
Other
could not be corrected by grinding, describe
that could not be corrected by grinding,
the situation and why grinding would not work
describe the situation and why grinding would
6 foot (half lane width)
in comments section.
not work in comments section.
12 foot (full lane width)
Method of Locating Grind Locations:
Inertial Profiler Distance Measuring
Instrument
GPS Coordinates
Accuracy of GPS Devise
Offset Distance from Semi-Permanent
Reference Points
Other Method
If other method, describe method in comments
section.
Comments:
Report Completed by (Print name)
Email
Phone Number
Date
Pavement Smoothness Correction Information Submittal to Caltrans
Submit an Adobe *.pdf file of this form to the resident engineer
Submitted by (Print name)
Date
within 2 business days after smoothness corrections and the final
inertial profiling of the pavement surface is completed.
Submitted by (Print name)
Date
Submit an Adobe *.pdf file of this form to the Department's secure file
sharing system within 2 business days after smoothness corrections
and the final inertial profiling of the pavement surface is completed.
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
ASPHALT CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
Page 5 of 5
CEM-3736AC (REV 09/2017)
FORM INFORMATION
GENERAL INFORMATION
This form is used to provide information about how pavement smoothness corrections are being made by the contractor to allow for evaluation
of the pavement smoothness specification.
For accurate inertial profile data, ensure that profiling data begins and ends at the same stations/post miles when multiple inertial profiles are
required. To ensure that pavement smoothness comparisons can be made between profiles, the beginning and ending stations/post miles and
semi-permanent reference points must be marked on the pavement shoulder and recorded in each profile run.
While collecting the profile data to determine the International Roughness Index values, record semi-permanent reference point locations and
the beginning and end of the following locations in the raw profile data:
1. Bridge approach slabs
2. Bridges
3. Culverts visible on the roadway surface
4. Railroad Crossings
5. At-grade intersections
6. Project limits
7. Change in pavement type
Submit an Adobe *.pdf file of this form to the resident engineer and the Department's secure file sharing system within 2 business days after
smoothness corrections and the final inertial profiling of the pavement surface is completed.
FORM
• Contract Number: For local agency encroachment permit projects, write the encroachment permit number in the Contract Number field.
• Co/Rte/PM: County, 2- or 3- letter abbreviation / route number / project post mile limits to the nearest tenth mile, such as 25.1.
• Project Identification Number: For local agency encroachment permit projects, write N/A in the field.
• Beginning and Ending Station/Post Mile: To the nearest foot, such as 10+20, or beginning post mile to the nearest hundredth, such as 25.06.
• Lane Number: Lane number (1, 2, 3,...) from left to right in the direction of travel.
• Direction: Traffic direction NB, SB, WB, or EB.
• Raw profile data file naming requirements:
YYYYMMDD_TTCCCRRR_EA_D_L_W_B_E_X_PT.PPF
where:
YYYY = year
MM = month, leading zero
DD = day of month, leading zero
TT = district, leading zero
CCC = county, 2- or 3-letter abbreviation as shown on the plans
RRR = route number, no leading zeros
EA = Contract number, excluding district identification number, expressed as 6 characters
D = traffic direction, NB, SB, WB, or EB
L = lane number from left to right in the direction of travel
W = wheel path, L for left, R for right, or B for both
B = beginning station to the nearest foot, such as 10+20, or beginning post mile to the nearest hundredth, such as 25.06, no leading zero
E = ending station to the nearest foot, such as 14+20, or ending post mile to the nearest hundredth, such as 28.06, no leading zero
X = profile operation, EXIST for existing pavement, INTER for after prepaving smoothness correction, MILL for after milling, PAVE for after
paving, and CORR for after final surface pavement correction
PT = type of HMA or concrete pavement profiled, such as Type A HMA, RHMA-G, CIR, JPCP, or CRCP
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.
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