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APPENDIX V <br />SAMPLE MATERIALS CERTIFICATION <br />Federal -aid Project No.: Project HP21L — 5055 —Ill <br />Subject: Materials Certification <br />This is to certify that the results of the tests on acceptance samples indicate that the materials <br />incorporated in the construction work and the construction operations controlled by sampling <br />® and testing were in conformity with the approved plans and specifications. <br />❑ All materials exceptions to the plans and specifications on this project are noted below. <br />No exceptions were found to the plans and specifications on this project. <br />Bill Sanders 24[Banders 7/7/07 <br />Resident Engineer (Print Name) Resident Engineer (Signature) (Date) <br />Dote: The signed original of this certificate is placed in the Resident Engineer's project files and one <br />copy is mailed to the DLAE and filed under "Report of Expenditures." <br />Attachments: Materials Exceptions (Acceptance Testing) <br />Type of <br />Description <br />Total Tests <br />Number <br />Action Taken <br />Test <br />of Work <br />Performed On <br />of Failed <br />the Pro ect <br />Tests <br />Slump Test <br />concrete <br />x <br />1 <br />When the measured slump nscce&d the <br />Sidewalk <br />inzzimum limit, the entire concrete bad was <br />rejected. <br />Sand <br />Aggregate <br />10 <br />1 <br />The toted S.E. was 70 and the contract <br />Equivalent <br />far Structural <br />compliance specification was 71 minimum. <br />Concrete <br />However, the concrete 28-day comptiesswe <br />Strength was 4900 psi. The concrete was <br />considered adequate and no materials <br />deductions were taken. <br />Compaction <br />Sob grade <br />12 <br />1 <br />One failed test was noted. The tiled area was <br />Material <br />watered and reworked Wbenthis was <br />completed, a tttest was performed The retest <br />was acceptable. <br />Compaction <br />Hot Mix As- <br />12 <br />1 <br />one failed area was noted. 1t was reworked <br />phah <br />and retested The second test met <br />specifications - <br />Bill Sanders <br />Resident Engineer (Print Name) <br />hTllliFx7FIv W <br />Resident Engineer (Signature) <br />July 4.2007 <br />Date <br />Page 21 of 25 Quality .assurance Plan 2019 <br />