Form CEM-3531 "Intelligent Compaction Hot Mix Asphalt Quality Control Report Checklist" - California

What Is Form CEM-3531?

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, 2019;
  • 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-3531 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
INTELLIGENT COMPACTION HOT MIX ASPHALT QUALITY CONTROL REPORT CHECKLIST
Page 1 of 3
CEM-3531 (NEW 07/2019)
PROJECT INFORMATION/NAME
CONTRACT NUMBER
CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CONTRACTOR NAME
Instructions: Contractor fills out and submits this form to ensure a complete hot mix asphalt (HMA) quality control report. The resident engineer
uses this form to verify that the submittals of the quality control report are complete.
For questions about this form send an email to:
IC@dot.ca.gov
HMA Placement Date
Quality control report submittals for hot mix asphalt placed on:
Hot Mix Asphalt Placement Information
HMA Placement Location
Direction
Lane Number
Beginning Station/Post Mile
Ending Station/Post Mile
HMA Type
HMA Thickness
Intelligent Compaction Data Analysis Technician
Data Analysis Technician (Print Name)
Data Analysis Training Completion Date
Email Address
Phone Number
Quality Control Report Submittal Preparer
Quality Control Report Completed by (Print Name)
Quality Control Report Completed by (Signature)
Date
Email Address
Phone Number
Intelligent Compaction Quality Control Report Submittals
Contractor Submittal
Submittal Review
This column is for Caltrans use
Check all that were submitted
Intelligent Compaction Quality Control Report Summary for Hot Mix Asphalt
Is submittal adequate?
Method Compaction
Yes
No
See Comments
Density Requirement
VETA Analysis Results Submitted
(Check all that apply)
Is submittal adequate?
Percent compliance with target roller passes
Yes
No
See Comments
Is submittal adequate?
Percent compliance with target HMA temperature for first
coverage of breakdown compaction
Yes
No
See Comments
Is submittal adequate?
Percent compliance with target HMA temperature for final
coverage of intermediate compaction
Yes
No
See Comments
Is submittal adequate?
Percent compliance with target HMA intelligent compaction
measurement value when measurement of intelligent compaction
Yes
No
See Comments
measurement value is required
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
INTELLIGENT COMPACTION HOT MIX ASPHALT QUALITY CONTROL REPORT CHECKLIST
Page 1 of 3
CEM-3531 (NEW 07/2019)
PROJECT INFORMATION/NAME
CONTRACT NUMBER
CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CONTRACTOR NAME
Instructions: Contractor fills out and submits this form to ensure a complete hot mix asphalt (HMA) quality control report. The resident engineer
uses this form to verify that the submittals of the quality control report are complete.
For questions about this form send an email to:
IC@dot.ca.gov
HMA Placement Date
Quality control report submittals for hot mix asphalt placed on:
Hot Mix Asphalt Placement Information
HMA Placement Location
Direction
Lane Number
Beginning Station/Post Mile
Ending Station/Post Mile
HMA Type
HMA Thickness
Intelligent Compaction Data Analysis Technician
Data Analysis Technician (Print Name)
Data Analysis Training Completion Date
Email Address
Phone Number
Quality Control Report Submittal Preparer
Quality Control Report Completed by (Print Name)
Quality Control Report Completed by (Signature)
Date
Email Address
Phone Number
Intelligent Compaction Quality Control Report Submittals
Contractor Submittal
Submittal Review
This column is for Caltrans use
Check all that were submitted
Intelligent Compaction Quality Control Report Summary for Hot Mix Asphalt
Is submittal adequate?
Method Compaction
Yes
No
See Comments
Density Requirement
VETA Analysis Results Submitted
(Check all that apply)
Is submittal adequate?
Percent compliance with target roller passes
Yes
No
See Comments
Is submittal adequate?
Percent compliance with target HMA temperature for first
coverage of breakdown compaction
Yes
No
See Comments
Is submittal adequate?
Percent compliance with target HMA temperature for final
coverage of intermediate compaction
Yes
No
See Comments
Is submittal adequate?
Percent compliance with target HMA intelligent compaction
measurement value when measurement of intelligent compaction
Yes
No
See Comments
measurement value is required
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
INTELLIGENT COMPACTION HOT MIX ASPHALT QUALITY CONTROL REPORT CHECKLIST
Page 2 of 3
CEM-3531 (NEW 07/2019)
PROJECT INFORMATION/NAME
CONTRACT NUMBER
CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CONTRACTOR NAME
VETA Analysis Result Submitted
(Check all that apply)
Contractor Submittal
Submittal Review
Check all that were submitted
This column is for Caltrans use
Is submittal adequate?
Final coverage histogram of number of passes for each roller
Yes
No
See Comments
Is submittal adequate?
For HMA thickness 0.15 foot or greater, final coverage histogram
of intelligent compaction measurement value of steel drum roller
Yes
No
See Comments
with vibratory on
Is submittal adequate?
Final coverage histogram of number of passes for each roller for
a sublot (fixed interval)
Yes
No
See Comments
Is submittal adequate?
For HMA thickness 0.15 foot or greater, final coverage histogram
of intelligent compaction measurement value of steel drum roller
Yes
No
See Comments
with vibratory on for a sublot (fixed interval)
Is submittal adequate?
All passes distribution histogram for each roller
Yes
No
See Comments
COMMENTS
Test Result Information
Contractor Submittal
Submittal Review
This column is for Caltrans use
Check all that were submitted
Is submittal adequate?
Hot mix asphalt mat temperature readings with corresponding
GPS coordinates
Yes
No
See Comments
Is submittal adequate?
Quality control density measurement and corresponding GPS
coordinates
Yes
No
See Comments
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
INTELLIGENT COMPACTION HOT MIX ASPHALT QUALITY CONTROL REPORT CHECKLIST
Page 3 of 3
CEM-3531 (NEW 07/2019)
PROJECT INFORMATION/NAME
CONTRACT NUMBER
CO/RTE/PM
PROJECT IDENTIFICATION NUMBER
CONTRACTOR NAME
Quality Control Manager Report Review
COMMENTS
I have reviewed the intelligent compaction results shown on the quality control report for compliance with the contract specifications and have
taken corrective action when required.
See comments for corrective actions taken
Quality Control Manager (Print Name)
Signature
Date Reviewed
Contractor's Submittal Documentation Quality Control Report
Submitted by (Print Name)
Date
Submit Adobe *.pdf file of the quality control
report to resident engineer within 1 business
day of HMA placement
Quality control report file name
Adobe *.pdf file name for quality control report:
Submitted by (Print Name)
Date
Submit Adobe *.pdf file of this form to resident
engineer within 1 business day of HMA
placement with the quality control report
submittal
Resident Engineers Review and Authorization of Quality Control Report
This section is for Caltrans use
Quality control report reviewed by (Print Name) Quality control report reviewed by (Signature)
Date
Does the quality control report comply with the specification requirement?
Quality control report is adequate
Quality control strip report does not comply with the specification requirements and must be resubmitted after addressing the comments
shown above.
Contractor notified of accepted or rejected quality control report by (Print Name)
Date
The intelligent compaction quality control report submitted by the contractor complies with the specification requirements.
Resident Engineer (Print Name)
Resident Engineer (Signature)
Date
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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