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APPENDIX V <br />SAMPLE MATERIALS CERTIFICATION <br />Federal -aid Project No.- Prowet HP21L — 5055 — Ill <br />Subject, Vaterials Certification <br />This is to certify that the results of the tests on acceptance samples indicate that the materials <br />incorporated in the constmction work and the construction operations controlled by sampling <br />® and testing were in confon ity with the approved plans and specifications_ <br />❑ All materials exceptions to the plans and specifications on this project are noted belmv. <br />No exceptions were found to the plans and specifications on this project_ <br />B111 Sanders Bill Sa n tiers 717f07 <br />Resident Engineer (Print wine) Resident Engineer {Signature) (Date) <br />Note: The signed original of this certificate is placed in the Resident EnPneer's project files and one <br />copy is wiled to the DLAE and filed under "Report of Expenditures_" <br />Attachments: _Materials Exceptions (Acceptance Testing) <br />T�-pe of <br />Description <br />Total Tests <br />Number <br />Action Taken <br />Test <br />of Work <br />Performed On <br />of Failed <br />the 1'raieet <br />Tests <br />Slump Test <br />Concrete <br />8 <br />1 <br />When the measured shine exceeded the <br />Sidewalk <br />maximum limit._ the entire concrete load was <br />rejected, <br />Sand <br />Aggregate <br />10 <br />1 <br />The tested S-E_ was 70 and the contact <br />Equivalent <br />for Structural <br />compliance specification was 71 miai mum. <br />Concrete <br />Howe, -er- the concrete 28-day compressive <br />strength was 4800 psi The concrete was <br />considered adequate and no materials <br />deductions were taken_ <br />Compaction <br />Sub grade <br />12 <br />1 <br />One failed test -was noted. The failed area was <br />Material <br />watered and reworked_ When this was <br />completed, a retest was performed. The retest <br />was acceptable. <br />Compaction <br />Hot Na As- <br />12 <br />1 <br />One failed area was noted. It was reworked <br />phalt <br />aad retested. The second test met <br />specifications. <br />Bill Sanders <br />Resident Engineer (Print Name) <br />Resident Engineer {Sigtratzue) <br />July 4. 2007 <br />Date <br />Page 21 of 25 Quality Assurance Plan 2019 <br />