Form CEM-3736C "Concrete Pavement Smoothness Corrections Information" - California

What Is Form CEM-3736C?

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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  • 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-3736C by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
CEM-3736C (REV 09/2017)
Page 1 of 4
Project Information/Name
Contract Number
CO/RTE/PM
Project Identification Number
Contractor Name
Use this form to provide information on pavement smoothness corrections. The information collected on this form will be used by the
Department of Transportation (Caltrans) to compare inertial profile data collected from existing pavement, post paving, and 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 (Route/Road/Street Name)
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)
Concrete Pavement
Concrete Pavement Type:
Jointed Plain Concrete Pavement
Continuously Reinforced Concrete Pavement
Precast Concrete Pavement
Raw profile data file name (*.ppf or *.pvp):
Post paving before corrections
Raw profile data file name (*.ppf or *.pvp):
Final after corrections
Concrete Pavement Preservation
Raw profile data file name (*.ppf or *.pvp):
Existing pavement
Raw profile data file name (*.ppf or *.pvp):
Final ground surface
Concrete Pavement Preservation With Slab Replacements
Raw profile data file name (*.ppf or *.pvp):
Existing pavement
Raw profile data file name (*.ppf or *.pvp):
Post slab replacement before corrections
Raw profile data file name (*.ppf or *.pvp):
After corrections
Overlay Existing Concrete Pavement
Raw profile data file name (*.ppf or *.pvp):
Existing pavement
Raw profile data file name (*.ppf or *.pvp):
Existing pavement post 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
CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
CEM-3736C (REV 09/2017)
Page 1 of 4
Project Information/Name
Contract Number
CO/RTE/PM
Project Identification Number
Contractor Name
Use this form to provide information on pavement smoothness corrections. The information collected on this form will be used by the
Department of Transportation (Caltrans) to compare inertial profile data collected from existing pavement, post paving, and 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 (Route/Road/Street Name)
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)
Concrete Pavement
Concrete Pavement Type:
Jointed Plain Concrete Pavement
Continuously Reinforced Concrete Pavement
Precast Concrete Pavement
Raw profile data file name (*.ppf or *.pvp):
Post paving before corrections
Raw profile data file name (*.ppf or *.pvp):
Final after corrections
Concrete Pavement Preservation
Raw profile data file name (*.ppf or *.pvp):
Existing pavement
Raw profile data file name (*.ppf or *.pvp):
Final ground surface
Concrete Pavement Preservation With Slab Replacements
Raw profile data file name (*.ppf or *.pvp):
Existing pavement
Raw profile data file name (*.ppf or *.pvp):
Post slab replacement before corrections
Raw profile data file name (*.ppf or *.pvp):
After corrections
Overlay Existing Concrete Pavement
Raw profile data file name (*.ppf or *.pvp):
Existing pavement
Raw profile data file name (*.ppf or *.pvp):
Existing pavement post 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
CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
CEM-3736C (REV 09/2017)
Page 2 of 4
PAVING SMOOTHNESS INFORMATION
Paving Information
Concrete deposited in front of paver by ready mix trucks
Concrete deposited in front of paver by end dumps
Concrete deposited in front of paver by material transfer device
Paver Automatic Controls
Automatic paver controls were not used
Fixed forms used
Wire line
One side
Both sides
For wire line, when used on only one side, was the other side controlled by?
Joint matcher
Automatic cross slope control
Joint matcher and automatic cross slope control
Joint matcher both sides
Was the joint matcher used on a previously corrected surface?
Yes
No
Automated Machine Guidance
GRINDING SMOOTHNESS INFORMATION
Automatic controls were not used
Constant depth of grinding was used
Automatic Machine Guidance
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
CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
CEM-3736C (REV 09/2017)
Page 3 of 4
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)
60 in/mile
120 in/mile
Other:
in/mile
Custom Grinder Information:
N/A
Other:
in/mile
feet
Grinder wheelbase
Number of grind locations required to meet
Number of grind locations required to meet
inch
Maximum grinding depth
areas of localized roughness:
mean roughness index:
Lf/L
Head position
Left wheel path number of grind
Left wheel path number of grind
locations
locations
feet
Tandem spread
Right wheel path number of grind
Right wheel path number of grind
feet
Short cutoff wavelength
locations
locations
Grind Location Determination:
Linear feet of grinding required to meet areas
Linear feet of grinding required to meet mean
of localized roughness requirement:
roughness index:
Grind locations were determined using ProVAL
smoothness assurance grind modeling?
Left wheel path linear feet
Left wheel path linear feet
Yes
No
Right wheel path linear feet
Right wheel path linear feet
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.
hours
hours
If there were areas of localized roughness that
If there were mean roughness index segments
Grinding Corrections:
could not be corrected by grinding, describe
that could not be corrected by grinding,
12 foot (full lane width)
the situation and why grinding would not work
describe the situation and why grinding would
Other
in comments section.
not work in comments section.
Method of Locating Grind Locations:
Inertial Profiler Distance Measuring Instrument
GPS Coordinates
Accuracy of GPS Devise
Offset Distances from Semi-Permanent
Reference Points
Other Method
If other method, describe method in comments
section.
Comments:
Report Completed by (Print name)
Email
Phone
Date
Pavement Smoothness Correction Information Submittal to Caltrans
Report Completed by (Print name)
Date
Submit an Adobe *.pdf file of this form to the resident engineer
within 2 business days after smoothness corrections and the final
inertial profiling of the pavement surface is completed.
Report Completed by (Print name)
Date
Submit an Adobe *.pdf file of this form to the Department's secure
file sharing system within 2 business day 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
CONCRETE PAVEMENT SMOOTHNESS CORRECTIONS INFORMATION
CEM-3736C (REV 09/2017)
Page 4 of 4
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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