Form CEM-3511 "Contractor Job Mix Formula Proposal" - California

What Is Form CEM-3511?

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 August 1, 2014;
  • 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-3511 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-3511 "Contractor Job Mix Formula Proposal" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONTRACTOR JOB MIX FORMULA PROPOSAL
Page 1 of 4
CEM-3511 (REV 8/2014)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
PROJECT INFORMATION/NAME
PHONE NUMBER
SUBMITTED BY CONTRACTOR (PRINT NAME AND SIGN)
DATE
JOB MIX FORMULA (JMF) INFORMATION
Hot Mix Asphalt (HMA) Type
HMA Grading
Scrap Tire Crumb Rubber Modifier Supplier
Producer Mix Identification Number
High Natural Crumb Rubber Modifier Supplier
Complete
HMA Producer Name and Address
Asphalt Modifier Source
for
RHMA
Asphalt Modifier Type
HMA Producer Phone Number
Asphalt Rubber Binder Producer
WMA Technology Source
Antistrip Source
Asphalt Binder Source
Provide JMF target values and
tolerances on page 2.
Provide aggregate and reclaimed asphalt
WMA Technology Product Name
Antistrip Type
Grade of Asphalt Binder
pavement (RAP) information on page 3.
(For resident engineer use only)
Qualified HMA Plant:
(Plants must be qualified under Material Plant Quality Program (MPQP) before production)
Yes
No
Approved Asphalt Binder Supplier:
(Reference: Hot Mix Asphalt Lab Certificate of Compliance Program)
Yes
No
Approved Warm Mix Asphalt Technology:
(Reference: Caltrans Approved Warm Mix Asphalt Technology webpage)
Yes
No
Job Mix Formula (JMF) Submittal:
CEM-3512 attached with Contractor hot mix asphalt design data
CEM-3513 attached, if applicable, with JMF verification
Material Safety Data Sheets (MSDS):
Supplemental Fines (except fines from dust collectors)
Antistrip
Asphalt Binder
WMA Additive
Asphalt Rubber Binder
Asphalt Modifier
Scrap Tire CRM
High Natural CRM
Materials Samples:
Samples requested by the engineer?
Yes
No
Samples taken under California Test 125 in the engineer's presence?
Yes
No
Aggregate
Supplemental Fines
Reclaimed Asphalt Pavement (RAP)
Antistrip
Asphalt Binder
Asphalt Rubber Binder
Warm Mix Asphalt Additive
JMF Submittal Complete:
Yes Date complete submittal received:
No Date contractor notified:
RESIDENT ENGINEER'S ACCEPTANCE
JMF complies with the specifications?
Yes
No
JMF verified within 12 months before production (CEM-3513 required)?
Yes
No
JMF accepted for use on contract number noted above?
Yes
No
Accepted by (print name and sign)
Title
Date
Rejected by (print name and sign)
Title
Date
Contractor notified of accepted or rejected JMF by
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
CONTRACTOR JOB MIX FORMULA PROPOSAL
Page 1 of 4
CEM-3511 (REV 8/2014)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
PROJECT INFORMATION/NAME
PHONE NUMBER
SUBMITTED BY CONTRACTOR (PRINT NAME AND SIGN)
DATE
JOB MIX FORMULA (JMF) INFORMATION
Hot Mix Asphalt (HMA) Type
HMA Grading
Scrap Tire Crumb Rubber Modifier Supplier
Producer Mix Identification Number
High Natural Crumb Rubber Modifier Supplier
Complete
HMA Producer Name and Address
Asphalt Modifier Source
for
RHMA
Asphalt Modifier Type
HMA Producer Phone Number
Asphalt Rubber Binder Producer
WMA Technology Source
Antistrip Source
Asphalt Binder Source
Provide JMF target values and
tolerances on page 2.
Provide aggregate and reclaimed asphalt
WMA Technology Product Name
Antistrip Type
Grade of Asphalt Binder
pavement (RAP) information on page 3.
(For resident engineer use only)
Qualified HMA Plant:
(Plants must be qualified under Material Plant Quality Program (MPQP) before production)
Yes
No
Approved Asphalt Binder Supplier:
(Reference: Hot Mix Asphalt Lab Certificate of Compliance Program)
Yes
No
Approved Warm Mix Asphalt Technology:
(Reference: Caltrans Approved Warm Mix Asphalt Technology webpage)
Yes
No
Job Mix Formula (JMF) Submittal:
CEM-3512 attached with Contractor hot mix asphalt design data
CEM-3513 attached, if applicable, with JMF verification
Material Safety Data Sheets (MSDS):
Supplemental Fines (except fines from dust collectors)
Antistrip
Asphalt Binder
WMA Additive
Asphalt Rubber Binder
Asphalt Modifier
Scrap Tire CRM
High Natural CRM
Materials Samples:
Samples requested by the engineer?
Yes
No
Samples taken under California Test 125 in the engineer's presence?
Yes
No
Aggregate
Supplemental Fines
Reclaimed Asphalt Pavement (RAP)
Antistrip
Asphalt Binder
Asphalt Rubber Binder
Warm Mix Asphalt Additive
JMF Submittal Complete:
Yes Date complete submittal received:
No Date contractor notified:
RESIDENT ENGINEER'S ACCEPTANCE
JMF complies with the specifications?
Yes
No
JMF verified within 12 months before production (CEM-3513 required)?
Yes
No
JMF accepted for use on contract number noted above?
Yes
No
Accepted by (print name and sign)
Title
Date
Rejected by (print name and sign)
Title
Date
Contractor notified of accepted or rejected JMF by
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
CONTRACTOR JOB MIX FORMULA PROPOSAL
Page 2 of 4
CEM-3511 (REV 8/2014)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
PROJECT INFORMATION/NAME
HOT MIX ASPHALT (HMA) TYPE/GRADING
PRODUCER MIX IDENTIFICATION NUMBER
Job Mix Formula¹
Specification Limits
For Engineer's
Material
Job Mix Formula Target Value
(Target Value ± Tolerance)
use
Aggregate
Meets specification?
Gradation
Yes
No
Sieve Size
2"
1½"
1"
¾"
½"
"
No. 4
No. 8
No. 16
No. 30
No. 50
No. 100
No. 200
RAP
2
Percentage
Antistrip
3,4
Percentage
WMA Production
WMA Additive
Temperature
5
Percentage
6
Range
Asphalt Binder
7,8
Percentage
RAP Asphalt
Binder Content
9
Percentage
RAP Specific
9
Gravity
This JMF has adjustments from the target values shown on CEM-3512?
(If yes, complete page 4.)
Yes
No
Note:
1
When the JMF target values are adjusted from target values shown on CEM-3512 provide the justification for the adjustment on page 4 Adjusted Job Mix
Formula and show the adjusted target values and specification limits here.
2
Percentage by dry weight of aggregate. Not allowed in RHMA-G and OGFC.
3
Liquid Antistrip must be between 0.25 and 1.0 percent by weight of asphalt binder.
4
Combined lime ratio must be between 0.8 and 1.5 by weight of dry aggregate (may be reduced to 0.5 to 1.0 for OGFC).
5
Percent admixture by weight of binder and HMA as recommended by the manufacturer.
6
Range must be between 290 °F and 325 °F. WMA produced under WMA Technology Option specification must be between 240 °F and 325 °F.
7
Percent by total weight of mixture (7.5% minimum for RHMA-G).
8
The engineer determines the optimum binder content for OGFC.
9
RAP average asphalt binder content percentage and RAP theoretical maximum specific gravity from CEM-3512 page 4 Reclaimed Asphalt Pavement
Aggregate Gradation, Asphalt Binder Content and Theoretical Maximum Specific Gravity.
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
CONTRACTOR JOB MIX FORMULA PROPOSAL
Page 3 of 4
CEM-3511 (REV 8/2014)
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
PROJECT INFORMATION/NAME
HOT MIX ASPHALT (HMA) TYPE/GRADING
PRODUCER MIX IDENTIFICATION NUMBER
AGGREGATE INFORMATION
Bin #1
Bin #2
Aggregate size
Aggregate size
Aggregate source
Aggregate source
California mine number
California mine number
SMARA identification number
SMARA identification number
Bin #3
Bin #4
Aggregate size
Aggregate size
Aggregate source
Aggregate source
California mine number
California mine number
SMARA identification number
SMARA identification number
Bin #5
Aggregate size
Aggregate source
California mine number
SMARA identification number
RAP INFORMATION
Bin #1
Bin #2
Aggregate size
Aggregate size
Aggregate source
Aggregate source
Average asphalt binder content percentage
Average asphalt binder content percentage
Theoretical maximum specific gravity
Theoretical maximum specific gravity
RAP Stockpile:
RAP Stockpile:
Static
Continuous
Static
Continuous
Stockpile size (tons)
Stockpile size (tons)
(For resident engineer use only)
Aggregate sources are the same as shown on CEM-3512?
Yes
No
Aggregate sources comply with SMARA requirement?
Yes
No
Reviewed 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
CONTRACTOR JOB MIX FORMULA PROPOSAL
Page 4 of 4
CEM-3511 (REV 8/2014)
CONTRACTOR NAME
PROJECT NAME
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
HMA TYPE/GRADING
PRODUCER NAME
PRODUCER MIX IDENTIFICATION NUMBER
DATE
ADJUSTED JOB MIX FORMULA (JMF)
Adjusted Target Value
Job Mix Formula
Adjusted Target
Adjusted Target Value
Specification Limits
Meets Specification?
Material
Target Value
Value
(After Failed
(Adjusted Target Value
from CEM-3512
(Before Verification)²
Verification)¹
± Tolerance)
Yes
No
Aggregate
Gradation
Sieve Size
2"
1½"
1"
¾"
½"
"
No. 4
No. 8
No. 16
No. 30
No. 50
No. 100
No. 200
RAP
Percentage
Antistrip
Percentage
WMA Additive
Percentage
Asphalt Binder
Percentage
RAP Asphalt
Binder content
Percentage²
RAP Specific
Gravity²
Notes:
1
Job mix formula (JMF) adjustments may include a change in the asphalt binder content target value up to ±0.2 percent, except do not adjust the target value
for asphalt rubber binder for RHMA-G below 7.5 percent by total weight of mixture. JMF adjustments may also include a change in the aggregate gradation
target values within the target value limits specified in the aggregate gradation tables.
2
RAP average asphalt binder content percentage and RAP theoretical maximum specific gravity from CEM-3512 page 4 Reclaimed Asphalt Pavement
Aggregate Gradation, Asphalt Binder Content and Theoretical Maximum Specific Gravity. A new JMF is required when adjustments for RAP asphalt binder
content exceed ± 2.0 percent or RAP specific gravity adjustment exceeds ± 0.60.
Justification for adjusting target values
Justification for adjusting target values 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.
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