Form CEM-3701 "Test Result Summary" - California

What Is Form CEM-3701?

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 March 1, 2015;
  • 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-3701 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
TEST RESULT SUMMARY
CEM-3701 (NEW 03/2015)
INDEX (CAT. - ITEM - TEST)
PROJECT INFORMATION/NAME
CONTRACTOR NUMBER
CO/RTE/PM
MINIMUM TESTING FREQUENCY
37-
PROJECT IDENTIFICATION NUMBER
TEST METHOD (CT/AASHTO/ASTM)
MATERIAL DESCRIPTION
CONTRACTOR NAME
RESIDENT ENGINEER NAME
SPECIFICATION REQUIREMENT
QUALITY CHARACTERISTIC
Sample Information
Test Information
Date Test
Date
Date
Date Test
Material
Date
Material
Result
Sample
Sample
Result
Test
Sample
Sample
Production
Sample
Test
Meets
Received
Shipped to
Received at
Provided to
REMARKS*
No.
Number
Location
Quantity
Taken
Result
Specification
from Lab
Lab
Lab
Contractor
Represented
(mm/dd/yy)
Requirement?
(mm/dd/yy)
(mm/dd/yy)
(mm/dd/yy)
(mm/dd/yy)
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
NO
YES
*REFERENCE FAILING TEST CORRECTIVE ACTION
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
TEST RESULT SUMMARY
CEM-3701 (NEW 03/2015)
INDEX (CAT. - ITEM - TEST)
PROJECT INFORMATION/NAME
CONTRACTOR NUMBER
CO/RTE/PM
MINIMUM TESTING FREQUENCY
37-
PROJECT IDENTIFICATION NUMBER
TEST METHOD (CT/AASHTO/ASTM)
MATERIAL DESCRIPTION
CONTRACTOR NAME
RESIDENT ENGINEER NAME
SPECIFICATION REQUIREMENT
QUALITY CHARACTERISTIC
Sample Information
Test Information
Date Test
Date
Date
Date Test
Material
Date
Material
Result
Sample
Sample
Result
Test
Sample
Sample
Production
Sample
Test
Meets
Received
Shipped to
Received at
Provided to
REMARKS*
No.
Number
Location
Quantity
Taken
Result
Specification
from Lab
Lab
Lab
Contractor
Represented
(mm/dd/yy)
Requirement?
(mm/dd/yy)
(mm/dd/yy)
(mm/dd/yy)
(mm/dd/yy)
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
NO
YES
*REFERENCE FAILING TEST CORRECTIVE ACTION
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
TEST RESULT SUMMARY
CEM-3701 (NEW 03/2015)
INSTRUCTIONS
GENERAL INFORMATION
This form must be used to monitor acceptance and verification testing performed by the Department of Transportationon on job-
produced materials, including those identified in the tables of 6-107, “Materials Acceptance Sampling and Testing,” of the Construction
Manual.
This form documents the frequency of testing performed on individual quality characteristics (e.g. relative compaction, modulus of
rupture, etc.) of materials and provides a means to monitor the timeliness of sampling and testing to those identified in Table 6-1.2 of
the Construction Manual.
Where failing tests are encountered, the form also serves to document those results and identify how the failed test was resolved (e.g.
corrective retest, specified deduction, etc.).
FORM
Minimum Testing Frequency: Frequency is generally identified within tables of 6-107, “Materials Acceptance Sampling and Testing,” of
the Construction Manual, but may be specified within the specifications.
Test Method: Identify the specified test method number(s) used to evaluate the individual quality characteristic (e.g. CT 217 for sand
equivalent, etc.).
Material Description: Identify the material constituent or material product associated with the item (e.g. coarse aggregate, fine
aggregate, binder, etc. or concrete, etc.).
Specification Requirement: Identify the specified acceptance value for the material's quality characteristic. Where both operating and
contract compliance values are specified, identify both.
Quality Characteristic: Identify the individual quality characteristic (e.g. relative compaction, modulus of rupture, etc.) being evaluated
by the sampling and testing.
Sample Number: Generally will correspond to the TL-0101 sample number.
Sample Location: Identify where the sample was taken.
Material Production Quantity Represented: Identify the quantity of material represented by the sample and test (e.g. 1000 cubic yards,
300 tons, etc.).
Remarks: In addition to resolution of failing test, may be used to reference supporting documentation (e.g. daily report, etc.) associated
with the sample and test.
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