Instructions for Form MTRB JC-1A, MTRB VJC-3A "Concrete & Grout Strength Test Report" - Hawaii

This document contains official instructions for Form MTRB JC-1A, and Form MTRB VJC-3A. Both forms are released and collected by the Hawaii Department of Transportation. An up-to-date fillable Form MTRB JC-1A is available for download through this link. The latest available Form MTRB VJC-3A can be downloaded through this link.

Instruction Details:

  • This 3-page document is available for download in PDF;
  • Actual and applicable for the current year;
  • Complete, printable, and free.

Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Hawaii Department of Transportation.

ADVERTISEMENT
ADVERTISEMENT

Download Instructions for Form MTRB JC-1A, MTRB VJC-3A "Concrete & Grout Strength Test Report" - Hawaii

498 times
Rate (4.7 / 5) 30 votes
1
4
3
2
6
7
5
8
9
11
10
13
12
14
15
16
17
18
19
21
20
22
24
23
25
26
27
28
29
30
31
1
4
3
2
6
7
5
8
9
11
10
13
12
14
15
16
17
18
19
21
20
22
24
23
25
26
27
28
29
30
31
INSTRUCTIONS FOR COMPLETING CONCRETE & GROUT STRENGTH TEST REPORT
(Form MTRB JC-1a, VJC-3a)
Refer to Circled Items on First Page
1
Highway or District Lab reviewing or testing the sample.
2
Sample number assigned by the Project Engineer/Inspector. The number should be in the following
format:
Usually a sequential number
Sequential number for that Project. (Start with
for a particular code, but
st
1 on the 1
sample card for a given project, and
other characters may be used
keep counting until your last sample card.)
or added for field office
convenience.
Code representing type of sample
represented by this transmittal. Use the
VJC - 55 - CA - 12B
following recommended codes:
CA
Concrete Class “A”
CB
Concrete Class “B”
CBD
Bridge Deck Concrete
CC
Concrete Class “C”
JC-Use this prefix for most jobs
CD
Concrete Class “D”
VJC-When sample card is for verification testing
CG
Grout
CLSM
Controlled Low Strength Material
CP
Paving Concrete
3
Project number (self explanatory)
CORE
Concrete Cores (Shotcrete, etc)
4
Date that the transmittal (JC) is prepared
CS
Concrete Special
5
Project Title (self explanatory)
CSCC
Self Consolidating Concrete
CSEAL Tremie Seal Concrete
6
Island (self explanatory)
CXXXX Designate by Strength XXXX psi for
7
Charge Code or work order number for project
> 4000 psi
8
Name of qualified person who sampled the material
9
Date and Time Material Sampled
10
Supplier of Concrete (i.e. Hawaiian Cement, Ameron)
11
Location of Concrete plant
12
Type of Concrete
13
Concrete Mix Number (Supplier Mix Number)
14
Truck Number that delivered concrete
15
Time Concrete left plant
16
Quantity Water Added on Jobsite (in gallons)
17
Slump (as measured on jobsite)
18
Temperature (as measured on jobsite)
19
Cubic Yards in Truck when Water Added
20
Density
21
Air Content
22
Grout Flow
23
Unit size of material sampled (i.e. CY, CF, etc.)
24
Quantity represented as applicable for each sample.
25
Where or what the material will be used for in this project
26
Payment item number (i.e., Item 503.1000). Multiple item numbers can be entered as needed.
27
Initial Curing Method. Cover with a removable cap, or other method? Specify other method used.
28
Record initial maximum and minimum curing temperature
29
Any other data required to clearly identify the material, test requirement and where it is required in the
contract document. Any notes as applicable (i.e., alternate use of the material and how transported). Any
Revised 5/5/2016
INSTRUCTIONS FOR COMPLETING CONCRETE & GROUT STRENGTH TEST REPORT
(Form MTRB JC-1a, VJC-3a)
remarks regarding sampling difficulties, field conditions that may affect samples, how samples taken, etc.
30 Name and signature of person submitting transmittal, email and phone number where the person can be
contacted especially when test data does not meet specifications, and District or County office where test
data or review comments should be sent to
31 To be completed by HWY-L
Revised 5/5/2016
Page of 3