Form CEM-3736 "Pavement Smoothness Inertial Profiler Submittal Record" - California

What Is Form CEM-3736?

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;
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Download a fillable version of Form CEM-3736 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-3736 "Pavement Smoothness Inertial Profiler Submittal Record" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
PAVEMENT SMOOTHNESS INERTIAL PROFILER SUBMITTAL RECORD
Page 1 of 4
CEM-3736 (REV 09/2017)
PROJECT INFORMATION/NAME
CONTRACT NUMBER
CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CONTRACTOR NAME
Use this form to record submittal of inertial profiler data files, reports, and calibration information. This form is for submittal of smoothness
information for two lanes. Submit this form within two days of performing inertial profiling. For questions about this form send an email to:
smoothness@dot.ca.gov.
PAVEMENT SMOOTHNESS GENERAL INFORMATION
Location (Route/Road/Street Name)
Beginning Station/Post Mile
Ending Station/Post Mile
Date Pavement Profiled
Smoothness Submittal First Lane Information
Smoothness Submittal Second Lane Information
Lane Number
Total No. of Lanes
Direction
Lane Number
Total No. of Lanes
Direction
INERTIAL PROFILER AND OPERATOR INFORMATION
Inertial Profiler Operator Name
Inertial Profiler Operator Email
Inertial Profiler Operator Phone Number
Inertial Profiler Operator Certification Date
Inertial Profiler Company Name
Cross-correlation Verification Test Date
Inertial Profiler Certification Date
Inertial Profiler Manufacturer
Inertial Profiler Model Number
PAVEMENT SMOOTHNESS INERTIAL PROFILER SUBMITTAL (Check submittal type)
Prepaving Existing Asphalt Concrete
Required for HMA with a prepaving grinding day bid item.
Prepaving existing asphalt concrete pavement
Prepaving post corrections
Hot Mix Asphalt
Hot Mix Asphalt Lift Thickness:
Information for Smoothness Database (check one)
foot
New pavement
Hot Mix Asphalt (Type A)
Post paving before corrections
Overlay over existing asphalt concrete
Overlay over cold planed/milled surface
Final after corrections
Overlay over cold in-place recycling surface
Rubberized Hot Mix Asphalt (RHMA-G)
Overlay over replace asphalt concrete surfacing
Post paving before corrections
Final after corrections
Overlay over concrete pavement
Overlay over concrete pavement with slab replacement
Open Graded Friction Course
Post paving before corrections
Overlay over crack and seat concrete pavement
Final after corrections
Cold Planing
foot
Existing pavement
Cold planed surface
Cold planning depth:
Cold In-place Recycling
Cold in-place recycling surface
Final cold in-place recycling surface after corrections Cold planning depth:
foot
Seal Coat
Existing pavement before seal coat
After corrections
Final seal coat surface
Concrete Pavement
Jointed Planned Concrete Pavement
Continuously Reinforced Concrete Pavement
Precast Concrete Pavement
Post paving before corrections
Post paving before corrections
Post paving before corrections
Final after corrections
Final after corrections
Final after corrections
Concrete Pavement Preservation
Existing concrete pavement
Final Ground pavement
Slab Replacement Concrete Pavement Preservation
Existing concrete pavement
Post slab replacement before corrections
After corrections
Overlay Existing Concrete Pavement
Existing pavement
Existing pavement post corrections
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
PAVEMENT SMOOTHNESS INERTIAL PROFILER SUBMITTAL RECORD
Page 1 of 4
CEM-3736 (REV 09/2017)
PROJECT INFORMATION/NAME
CONTRACT NUMBER
CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CONTRACTOR NAME
Use this form to record submittal of inertial profiler data files, reports, and calibration information. This form is for submittal of smoothness
information for two lanes. Submit this form within two days of performing inertial profiling. For questions about this form send an email to:
smoothness@dot.ca.gov.
PAVEMENT SMOOTHNESS GENERAL INFORMATION
Location (Route/Road/Street Name)
Beginning Station/Post Mile
Ending Station/Post Mile
Date Pavement Profiled
Smoothness Submittal First Lane Information
Smoothness Submittal Second Lane Information
Lane Number
Total No. of Lanes
Direction
Lane Number
Total No. of Lanes
Direction
INERTIAL PROFILER AND OPERATOR INFORMATION
Inertial Profiler Operator Name
Inertial Profiler Operator Email
Inertial Profiler Operator Phone Number
Inertial Profiler Operator Certification Date
Inertial Profiler Company Name
Cross-correlation Verification Test Date
Inertial Profiler Certification Date
Inertial Profiler Manufacturer
Inertial Profiler Model Number
PAVEMENT SMOOTHNESS INERTIAL PROFILER SUBMITTAL (Check submittal type)
Prepaving Existing Asphalt Concrete
Required for HMA with a prepaving grinding day bid item.
Prepaving existing asphalt concrete pavement
Prepaving post corrections
Hot Mix Asphalt
Hot Mix Asphalt Lift Thickness:
Information for Smoothness Database (check one)
foot
New pavement
Hot Mix Asphalt (Type A)
Post paving before corrections
Overlay over existing asphalt concrete
Overlay over cold planed/milled surface
Final after corrections
Overlay over cold in-place recycling surface
Rubberized Hot Mix Asphalt (RHMA-G)
Overlay over replace asphalt concrete surfacing
Post paving before corrections
Final after corrections
Overlay over concrete pavement
Overlay over concrete pavement with slab replacement
Open Graded Friction Course
Post paving before corrections
Overlay over crack and seat concrete pavement
Final after corrections
Cold Planing
foot
Existing pavement
Cold planed surface
Cold planning depth:
Cold In-place Recycling
Cold in-place recycling surface
Final cold in-place recycling surface after corrections Cold planning depth:
foot
Seal Coat
Existing pavement before seal coat
After corrections
Final seal coat surface
Concrete Pavement
Jointed Planned Concrete Pavement
Continuously Reinforced Concrete Pavement
Precast Concrete Pavement
Post paving before corrections
Post paving before corrections
Post paving before corrections
Final after corrections
Final after corrections
Final after corrections
Concrete Pavement Preservation
Existing concrete pavement
Final Ground pavement
Slab Replacement Concrete Pavement Preservation
Existing concrete pavement
Post slab replacement before corrections
After corrections
Overlay Existing Concrete Pavement
Existing pavement
Existing pavement post corrections
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
PAVEMENT SMOOTHNESS INERTIAL PROFILER SUBMITTAL RECORD
Page 2 of 4
CEM-3736 (REV 09/2017)
PROFILE DATA FILE SUBMITTED (Check files submitted)
Raw profile data for each lane
Raw Profile Data File Name (*.ppf or *.pvp):
Lane Number
Direction
Raw Profile Data File Name (*.ppf or *.pvp):
Lane Number
Direction
ProVAL REPORTS AND CALIBRATION INFORMATION SUBMITTED (Check files submitted)
ProVAL Ride Quality Reports (One file per lane)
ProVAL ride quality analysis report for areas of localized roughness (25 foot, short continuous) of the left and right wheel paths of each lane.
Combine the left and right wheel paths into a single file lane report.
PDF File Name (*.pdf):
Lane Number
Direction
PDF File Name (*.pdf):
Lane Number
Direction
ProVAL ride quality analysis report for Mean Roughness Index of each lane
PDF File Name (*.pdf):
Lane Number
Direction
PDF File Name (*.pdf):
Lane Number
Direction
ProVAL Smoothness Assurance Module Reports (One file per wheel path)
ProVAL smoothness assurance analysis report for the International Roughness Index of the left and right wheel paths of each lane
Not required, final pavement smoothness submittal or Revised Standard Specifications dated July 21, 2017, or later.
PDF File Name (*.pdf):
Lane
Left Wheel Path
Number:
Direction:
PDF File Name (*.pdf):
Right Wheel Path
PDF File Name (*.pdf):
Lane
Left Wheel Path
Number:
Direction:
PDF File Name (*.pdf):
Right Wheel Path
ProVAL smoothness assurance analysis reports for the grinding locations of the left and right wheel paths of each lane
Not required, final pavement smoothness submittal or Revised Standard Specifications dated July 21, 2017, or later.
PDF File Name (*.pdf):
Lane
Left Wheel Path
Number:
Direction:
PDF File Name (*.pdf):
Right Wheel Path
PDF File Name (*.pdf):
Lane
Left Wheel Path
Number:
Direction:
PDF File Name (*.pdf):
Right Wheel Path
GPS data file for each lane
GPS Data File Name (*.gpx):
Lane Number
Direction
GPS File Name (*.gpx):
Lane Number
Direction
Manufacturer's recommended calibration and verification test results for the inertial profiler.
Inertial profiler's calibration and verification test results, including bounce, block, and distance measurement instrument.
MULTIPLE INERTIAL PROFILE DATA FILES (Check if applicable)
Zip File Name (*.zip):
Multiple inertial profiler data files submitted
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
PAVEMENT SMOOTHNESS INERTIAL PROFILER SUBMITTAL RECORD
Page 3 of 4
CEM-3736 (REV 09/2017)
Pavement Smoothness Correction ProVAL Smoothness Analysis Input Information and Results
ProVAL Analysis by Name
ProVAL Analysis by Email
ProVAL Analysis by Phone Number
Grinder Information
Areas of Localized Roughness
Mean Roughness Index
Grinding required to meet areas localized
Grinding required to meet mean roughness
Type of Grinder
roughness?
index?
18 foot wheelbase
Yes
No
Yes
No
25 foot wheelbase
Areas of localized roughness smoothness
Mean roughness index smoothness assurance
Custom Grinder
assurance report analysis based on:
report analysis based on:
60 in/mile
75 in/mile
120 in/mile
160 in/mile
Other:
180 in/mile
Other:
in/mile
in/mile
Areas of localized roughness values
Mean roughness index values determined for
Custom Grinder Information
determined for each wheel path for a 25-foot
lane segment for a 528-foot fixed length using
feet
section using a 250-mm filter?
a 250-mm filter?
Grinder Wheel Base
Yes
No
Yes
No
inch
Maximum Grinding Depth
Lf/L
Number of grind locations required to meet
Number of grind locations required to meet
Head Position
areas of localized roughness:
mean roughness index:
feet
Tandem Spread
Left wheel path number of grind
Left wheel path number of grind
feet
Short Cutoff Wavelength
locations
locations
Right wheel path number of grind
Right wheel path number of grind
locations
locations
Linear feet of grinding required to meet areas
Linear feet of grinding required to meet mean
of localized roughness requirement:
roughness index:
Left wheel path linear feet
Left wheel path linear feet
Right wheel path linear feet
Right wheel path linear feet
Pavement Smoothness Record General Information
Comments:
Report Completed by (Print name)
Signature
Date
Pavement Smoothness Inertial Profile Reports Review
Comments:
I have reviewed the pavement smoothness results included in this submittal for compliance with the contract specifications and taken corrective
action when required to ensure compliance with the specification requirements.
Signature
Date Reviewed
Quality Control Manager (Print name)
Pavement Smoothness Quality Report Submittal to Caltrans
Submitted by (print name)
Date
Submit inertial profile data reports and calibration information to
resident engineer within 2 business days of pavement inertial
profiling.
Include an Adobe *.pdf file of this form with the submittal.
Submitted by (print name)
Date
Submit inertial profile data reports and calibration information to
the Department's secure file sharing system within 2 business
days of pavement inertial profiling. Send a notification of the
submittal to:
smoothness@dot.ca.gov
Include an Adobe *.pdf file of this form with the notification.
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
PAVEMENT SMOOTHNESS INERTIAL PROFILER SUBMITTAL RECORD
Page 4 of 4
CEM-3736 (REV 09/2017)
FORM INFORMATION
GENERAL INFORMATION
This form is used by the contractor to record pavement smoothness submittal of initial profiler data files, reports, and calibration information.
For accurate inertial profile data, ensure that profiling data begins and ends at the same stations/post miles when multiple 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 the following leave-out locations in the raw
profile data at the beginning and end of all:
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.
Submittal inertial profile data reports and calibration information to resident engineer within 2 business days of pavement inertial profiling.
Include an Adobe *.pdf file of this form with the submittal.
Submit inertial profile data reports and calibration information to the Department's secure file sharing system within 2 business days of
pavement inertial profiling. Send a notification of the submittal to: smoothness@dot.ca.gov. Include an Adobe *.pdf file of this form with the
notification.
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 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
• If submitting multiple inertial profiler data files, compress the files into a zip format and submit them using the file-naming convention
TT_EA_X_YYYYMMDD.zip.
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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