Instructions for Form MTRB JC-1, MTRB CJC-2, MTRB VJC-3 "Transmittal for Material Review/Testing" - Hawaii

This document contains official instructions for Form MTRB JC-1, Form MTRB CJC-2, and Form MTRB VJC-3. All forms are released and collected by the Hawaii Department of Transportation. An up-to-date fillable Form MTRB JC-1 is available for download through this link. The latest available Form MTRB CJC-2 can be downloaded through this link. Form MTRB VJC-3 can be found here.

Instruction Details:

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Download Instructions for Form MTRB JC-1, MTRB CJC-2, MTRB VJC-3 "Transmittal for Material Review/Testing" - Hawaii

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INSTRUCTIONS FOR COMPLETING TRANSMITTALS FOR ACCEPTANCE,
CONTRACTOR AND VERIFICATION SAMPLING AND TESTING
(Forms MTRB JC-1, MTRB CJC-2, and MTRB VJC-3)
Refer to Circled Items on First Page
1
Lab section reviewing or testing the sample.
2
Check Resubmittal
3
Sample number assigned by the Project Engineer. The number should be in the following format:
JC-Use this prefix for most jobs
Sequential number for that Project. (Start with
st
CJC-When sample card represents contractor test
1 on the 1
sample card for a given project, and
VJC-When sample card is for verification testing
keep counting until your last sample card.)
JC - 55 - ACB - 12B
Code representing type of sample represented by this transmittal. Use the
Usually a sequential number
following recommended codes:
for a particular code, but
other characters may be used
*
AB
Aggregate Base Course
CSCC
Self Consolidating Concrete
or added for field office
*
AC
Asphalt Concrete
CSEAL Tremie Seal Concrete
convenience.
ACA
Asphalt Concrete Aggregates
CXXXX Designate by Strength XXXX psi for
*
> 4000 psi
ACB
Asphalt Concrete Base
ASB
Aggregate Subbase Course
EM
Excavation & Embankment
BC
Bed Course for Pipes
FM
Filter Material
*
CA
Concrete Class “A”
IB
Import Borrow
CAG
Concrete Aggregates
Miscellaneous (Includes material
M
certifications)
*
CB
Concrete Class “B”
*
CBD
Bridge Deck Concrete
PM
Pavement Marking Materials
*
CC
Concrete Class “C”
RS
Reinforcing Steel
*
CD
Concrete Class “D”
SF
Structural Fill
*
CG
Concrete Groute
TB
Trench Backfill
*
CLSM
Controlled Low Strength Material
WC
Weekly Compaction Report
*
CORE
Concrete Cores (Shotcrete, etc)
*
CS
Concrete Special
*
Usually used for JC-2a, CJC-2a, and VJC-2a
4
Project number (self explanatory)
5
Date that the transmittal (JC) is prepared
6
Project Title (self explanatory)
7
Island (self explanatory)
8
Name exact material or item being submitted for testing or review. If a certificate of compliance is being
submitted, indicate “Certificate of Compliance for (name of item)” for the item being submitted. (Be
sure the Certificate of Compliance is specific as to what is being certified. It should not list items not in
the project.)
9
Actual quantity submitted with the transmittal (JC)
10
Type of material the quantity applies to.
11
Manufacturer or Brand of the material being submitted.
12
Source of supplier of the material being submitted.
Revised 5/5/2016
INSTRUCTIONS FOR COMPLETING TRANSMITTALS FOR ACCEPTANCE,
CONTRACTOR AND VERIFICATION SAMPLING AND TESTING
(Forms MTRB JC-1, MTRB CJC-2, and MTRB VJC-3)
13
Where or what the material will be used for in this project
14
Name of person who sampled the material. This does not need to be filled in if a sample is not being
submitted (such as a Certificate of Compliance).
15
Date the sample was taken
16
Where sampled: jobsite; (name) of quarry; etc. as applicable.
17
Date sample was shipped to the lab.
18
Quantity represented: __tons; __C.Y.; __each; etc. as applicable for each sample.
19, 20
Specific section or subsection, plan sheet number, or change order number where the referenced
material is specified and the quality requirements are indicated.
21
Payment item number (i.e., Item 206.7200). Multiple item numbers can be entered as needed.
22
Any other data required to clearly identify the material, test requirement and where it is required in the
contract document.
23 Any notes as applicable (i.e., alternate use of the material, number of sample bags, and how shipped).
Any remarks regarding sampling difficulties, field conditions that may affect samples, how samples taken,
etc.
24 Name and signature of person submitting transmittal.
25 District or County office where test data or review comments should be sent to
26 Phone number where the person can be contacted especially when test data does not meet specifications
27 Email where the person can be contacted especially when test data does not meet specifications
28 For HWY-L response only.
Revised 5/5/2016
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