FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5 th St. Vancouver, Washington 98661 FP-03 109.01 Date Stamp (a) Project Name: Project Number: (b) Item Number: Item Description: (c) Date work performed: Copy Stamp Daily Record Of Miscellaneous Items (f) Calculations*: (g) Supporting sketch and details*: Summary of Quantities (d) Location: (e) Measured quantity: *Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work: FHWA Use Only (i) Interim Measurement Final Measurement Verified By: Construction Inspector I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record Checked By: (j) Contractor Representative FHWA Representative Date: 40101 Superpave Hot Asphalt Concrete Pavement 35+840 to 34+338 (plus 3 loads for turnouts): 1187.47 t Lot 2 See the following attachments: (a) daily mass record WFLHD 422M (b) street delivery report, spread report WFLHD 434 (c) ticket check MS Excel spreadsheet see above stations 1187.47 t 1187.5 t Page 77 of 134
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
40101Superpave Hot Asphalt Concrete Pavement
35+840 to 34+338 (plus 3 loads for turnouts): 1187.47 t
Lot 2
See the following attachments:(a) daily mass record WFLHD 422M(b) street delivery report, spread report WFLHD 434(c) ticket check MS Excel spreadsheet
see above stations 1187.47 t
1187.5
t
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
40105Antistrip Additive
9/11 = 26.4 tons9/14 = 28.7 tons9/16 = 27.2 tons
= 82.3 tons total
8,700.97 tons of Superpave Pavement Placed, @ 5.5% AC mix design = 8,222.41 tons of rockAntistrip Additive added at 1% per weight of rock = 82.2 tons
Invoice totals verified by weight of total tons placed
See attachments
82.3
82.3
t
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
Be sure to check the contractors application rate
41201Tack Coat
Attached Ticket: 5.09 tons = 5.1 tons
Station 20+05 to Station 121+84 = 10,179 feet @ 12' wide = 122,148 SQ FT = 13572 SYTack applied at 0.09 gal/SY = 1221.48 gal @ 240 gal/ton = 5.0895 tons
Weigh ticket matches measured verified by measured calculations
See attachments
5.1
5.1
t
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