Form CEM-3804 "Hot Mix Asphalt Inspection and Testing Summary" - California

What Is Form CEM-3804?

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 April 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-3804 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-3804 "Hot Mix Asphalt Inspection and Testing Summary" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
HOT MIX ASPHALT INSPECTION AND TESTING SUMMARY
CEM-3804 (NEW 04/2009)
CONTRACTOR NAME, ADDRESS, AND PHONE NUMBER
DATE
CONTRACT NUMBER/CO/RTE/PM
PRODUCER MIX IDENTIFICATION NUMBER
HMA TYPE
This form must be submitted with daily inspection and testing reports attached. All attached forms must have inspector's or tester's signature and quality control manager's
initials. Use additional sheet as necessary.
The following documents are attached to this Hot Mix Asphalt inspection and testing summary:
CEM-3501 Hot Mix Asphalt (HMA) Production Report
CEM-3502 Hot Mix Asphalt (HMA) Placement Report
CEM-3803 Daily Summary of Quality Control Testing (with attached test forms)
CT 379 or CT 382
CT 202
Density (includes CT 308 and CT 309)
CT 217
CT 266 or CT 370
CT
CT
CT
Explanation of deviations from the specifications or regular practices
I certify that the information contained in this record is accurate, and that information, tests, or calculations documented here comply with the contract specifications and
the standards set forth in the testing procedures. Exceptions to this certification are documented as part of this record.
Quality Control Manager's Signature
Date
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
ADA Notice
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
HOT MIX ASPHALT INSPECTION AND TESTING SUMMARY
CEM-3804 (NEW 04/2009)
CONTRACTOR NAME, ADDRESS, AND PHONE NUMBER
DATE
CONTRACT NUMBER/CO/RTE/PM
PRODUCER MIX IDENTIFICATION NUMBER
HMA TYPE
This form must be submitted with daily inspection and testing reports attached. All attached forms must have inspector's or tester's signature and quality control manager's
initials. Use additional sheet as necessary.
The following documents are attached to this Hot Mix Asphalt inspection and testing summary:
CEM-3501 Hot Mix Asphalt (HMA) Production Report
CEM-3502 Hot Mix Asphalt (HMA) Placement Report
CEM-3803 Daily Summary of Quality Control Testing (with attached test forms)
CT 379 or CT 382
CT 202
Density (includes CT 308 and CT 309)
CT 217
CT 266 or CT 370
CT
CT
CT
Explanation of deviations from the specifications or regular practices
I certify that the information contained in this record is accurate, and that information, tests, or calculations documented here comply with the contract specifications and
the standards set forth in the testing procedures. Exceptions to this certification are documented as part of this record.
Quality Control Manager's Signature
Date
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
ADA Notice
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.