Form CEM-3803 "Daily Summary of Quality Control Testing" - California

What Is Form CEM-3803?

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 July 1, 2016;
  • The latest edition provided by the California Department of Transportation;
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  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-3803 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-3803 "Daily Summary of Quality Control Testing" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 1 of 3
DAILY SUMMARY OF QUALITY CONTROL TESTING
CEM-3803 (REV 07/2016)
CONTRACTOR NAME, ADDRESS, AND PHONE NUMBER
DATE
CONTRACT NUMBER/CO/RTE/PM
PRODUCER MIX IDENTIFICATION NUMBER
HMA TYPE
This form must be submitted with all daily testing reports. Circle all test results that are
LOT NUMBER
not within the Action Limits. Use additional sheets as necessary.
Test Result
Test Result
Test Result
Test Result
Sublot
Sublot
Sublot
Sublot
Number
Number
Number
Number
Quality Characteristic
Test Method
Testing Frequency
AGGREGATE TESTING
Aggregate gradation
AASHTO T 27
1 per 750 tons and any remaining part
(% passing, report to tenth)
Sieve Size
2"
1 1/2"
1"
3/4"
1/2"
3/8"
No. 4
No. 8
No. 16
No. 30
No. 50
No. 100
No. 200
Sand Equivalent
AASHTO T 176
1 per 750 tons and any remaining part
Aggregate Moisture Content
AASHTO T 255
1 per 750 tons and any remaining part
(continuous mixing plants only)
Los Angeles Rattler,
AASHTO T 96
1 per 10,000 tons, 2 min per project
Loss at 100 Rev. (%)
Los Angeles Rattler,
AASHTO T 96
1 per 10,000 tons, 2 min per project
Loss at 500 Rev. (%)
Crushed particles, course aggregate
AASHTO T 335
1 per 10,000 tons, 2 min per project
(%) One fractured face
Crushed particles, course aggregate
AASHTO T 335
1 per 10,000 tons, 2 min per project
(%) Two fractured face
Crushed particles, fine aggregate
AASHTO T 335
1 per 10,000 tons, 2 min per project
(%) One fractured face
AASHTO T 304
Fine aggregate angularity (%)
1 per 10,000 tons, 2 min per project
(Method A)
Flat and elongated particles
ASTM D 4791
1 per 10,000 tons, 2 min per project
(% by mass 5:1)
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 1 of 3
DAILY SUMMARY OF QUALITY CONTROL TESTING
CEM-3803 (REV 07/2016)
CONTRACTOR NAME, ADDRESS, AND PHONE NUMBER
DATE
CONTRACT NUMBER/CO/RTE/PM
PRODUCER MIX IDENTIFICATION NUMBER
HMA TYPE
This form must be submitted with all daily testing reports. Circle all test results that are
LOT NUMBER
not within the Action Limits. Use additional sheets as necessary.
Test Result
Test Result
Test Result
Test Result
Sublot
Sublot
Sublot
Sublot
Number
Number
Number
Number
Quality Characteristic
Test Method
Testing Frequency
AGGREGATE TESTING
Aggregate gradation
AASHTO T 27
1 per 750 tons and any remaining part
(% passing, report to tenth)
Sieve Size
2"
1 1/2"
1"
3/4"
1/2"
3/8"
No. 4
No. 8
No. 16
No. 30
No. 50
No. 100
No. 200
Sand Equivalent
AASHTO T 176
1 per 750 tons and any remaining part
Aggregate Moisture Content
AASHTO T 255
1 per 750 tons and any remaining part
(continuous mixing plants only)
Los Angeles Rattler,
AASHTO T 96
1 per 10,000 tons, 2 min per project
Loss at 100 Rev. (%)
Los Angeles Rattler,
AASHTO T 96
1 per 10,000 tons, 2 min per project
Loss at 500 Rev. (%)
Crushed particles, course aggregate
AASHTO T 335
1 per 10,000 tons, 2 min per project
(%) One fractured face
Crushed particles, course aggregate
AASHTO T 335
1 per 10,000 tons, 2 min per project
(%) Two fractured face
Crushed particles, fine aggregate
AASHTO T 335
1 per 10,000 tons, 2 min per project
(%) One fractured face
AASHTO T 304
Fine aggregate angularity (%)
1 per 10,000 tons, 2 min per project
(Method A)
Flat and elongated particles
ASTM D 4791
1 per 10,000 tons, 2 min per project
(% by mass 5:1)
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 2 of 3
DAILY SUMMARY OF QUALITY CONTROL TESTING
CEM-3803 (REV 07/2016)
CONTRACTOR NAME, ADDRESS, AND PHONE NUMBER
DATE
CONTRACT NUMBER/CO/RTE/PM
PRODUCER MIX IDENTIFICATION NUMBER
HMA TYPE
LOT NUMBER
Test Result
Test Result
Test Result
Test Result
Sublot
Sublot
Sublot
Sublot
Quality Characteristic
Test Method
Testing Frequency
Number
Number
Number
Number
RECLAIMED ASPHALT PAVEMENT (RAP)
RAP Moisture Content
AASHTO T 255
1 per 750 tons and any remaining part
RAP Gradation
CT 384
Once a day
Binder Content of RAP (% within
1 per 1,000 tons, min of 6 per fractioned RAP
AASHTO T 164
average value reported)
stockpile. If augmented then 1 per 500 tons
Specific Gravity of RAP (within the
1 per 1,000 tons, min of 6 per fractioned RAP
AASHTO T 209
average value reported
stockpile. If augmented then 1 per 500 tons
ASPHALT BINDER TESTING
Certificates of Compliance required per
Various, See Standard
Departments Certification Program for
Various Testing
Specification Section 92
Suppliers of Asphalt. In Engineer's presence,
take two 1-quart samples per day
HOT MIX ASPHALT
Asphalt binder content (%)
AASHTO T 308, Method A
1 per 750 tons and any remaining part
1 per 2,500 tons
HMA Moisture Content (%)
AASHTO T 329
(but not less than 1 per day)
1 per 4,000 tons, or 2 per
Air Voids Content (%)
AASHTO T 269
project, whichever is greater
MS-2 Asphalt Mixture
1 per 10,000 tons, or 2 per
Voids in mineral aggregate (%)
Volumetrics
project, whichever is greater
MS-2 Asphalt Mixture
1 per 10,000 tons, or 2 per
Dust proportion
Volumetrics
project, whichever is greater
1 per 10,000 tons, or 1 per
Hamburg Wheel Track
AASHTO T 324 (Modified)
project, whichever is greater
1 per 10,000 tons, or 1 per
Moisture susceptibility
AASHTO T 283
project, whichever is greater
DENSITY
Density (Nuclear Gauge
3 per 250 tons or 3 per paving
CT 375
calibrated to cores)
day, whichever is greater
2 per paving day
Density of Core
CT 375
Density, Tapered Notched Wedge
1 per 750-foot section along joint
CT 375
(calibrated nuclear gauge)
Provide additional cores for Engineers Acceptance Testing, 1 core per 250 tons, random locations determined by the Engineer, at least once every 5 business days
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 3 of 3
DAILY SUMMARY OF QUALITY CONTROL TESTING
CEM-3803 (REV 07/2016)
CONTRACTOR NAME, ADDRESS, AND PHONE NUMBER
DATE
CONTRACT NUMBER/CO/RTE/PM
PRODUCER MIX IDENTIFICATION NUMBER
HMA TYPE
LOT NUMBER
Test Result
Test Result
Test Result
Test Result
Sublot
Sublot
Sublot
Sublot
Number
Number
Number
Number
Quality Characteristic
Test Method
Testing Frequency
ASPHALT MODIFIER FOR ASPHALT RUBBER BINDER
Viscosity (Asphalt Modifier for
ASTM D445
1 per shipment
Asphalt Rubber Binder)
Flash point (Asphalt Modifier for
ASTM D92
1 per shipment
Asphalt Rubber Binder)
Molecular Analysis (Asphalt
ASTM D2007
1 per shipment
Modifier for Asphalt Rubber Binder)
CRUMB RUBBER MODIFIER FOR ASPHALT RUBBER BINDER
Natural rubber content in high
ASTM D297
1 per 3,400 lb
natural crumb rubber
High natural crumb rubber gradation
CT 385
1 per 3,400 lb
Scrap tire crumb rubber gradation
CT 385
1 per 10,000 lb
Wire in CRM
CT 385
1 per 10,000 lb
Fabric in CRM
CT 385
1 per 10,000 lb
CRM particle length
---
1 per 10,000 lb
CRM specific gravity
CT 208
1 per 10,000 lb
ASPHALT RUBBER BINDER
Cone Penetration (Asphalt Rubber
ASTM D217
1 per lot (lot defined in MPQP)
Binder)
Resilience (Asphalt Rubber Binder)
ASTM D5329
1 per lot (lot defined in MPQP)
Softening Point (Asphalt Rubber
ASTM D36/D36M
1 per lot (lot defined in MPQP)
Binder)
15 minutes before use per lot
Viscosity
ASTM D7741/D7741M
(lot defined in MPQP)
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When the special provisions require additional quality control testing, use the blank lines above to record quality characteristics test methods, testing frequencies, and test results.
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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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