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HomeMy WebLinkAboutCAG-20-065 - Duvall - Crushed Surfacing Top Course y . 1 , mivirmimi Washington State Department of Transportation Request for Approval of Material Contract Number FA Number N/A SR Duvall Ave NE Date CAG 20-065 12/16/2021 • Section/Title of Project Duvall Ave NE County King Contractor Reed Trucking & Excavating, Inc. Subcontractor This form shall be completed prior to submittal.If this form is not compete at time of submittal it may. For WSDOT Use Only be returned for Information that was omitted. RAM# 059&061 PE Use Bld Item Material or . Name and Location of Fabricator, Specification PEIQFL HdgtrJQPL HQ Use No. Product/Type Manufacturer or Pit Number . Reference Code Code A35; • CSTC Black River Quarry 4-04 10 IIA44-52, 86-B9 . ` -• • ( Project Engineer/Representative i Date State Materials Engineer/Representative Date • L._ \ ____ 12116/2021 . Acceptance Action Codes for use by Project Engineer and State Materials Laboratory 1. Acceptance Criteria: Acceptance based upon"Satisfactory"Test Report for samples of materials to be incorporated into • project. - 2. Acceptance Criteria: Mfg.Cert of Compliance for'Acceptance'prior to use of material. 3. Acceptance Criteria: Catalog Cuts for'Acceptance'prior to use of material.Catalog Cut Approved ❑Yes ❑No 4. Acceptance Criteria: Submit Shop Drawings for'Approval'prior to fabrication of material. . 5. Acceptance Criteria: Only'Approved for Shipment','WSDOT Inspected'or'Fabrication Approved Decal'material shall be used. 6. Acceptance Criteria: Submit Certificate of Materials Origin to.Project Engineer Office. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action. 8. Source Approved: 9. Approval Withheld: Submit samples for preliminary evaluation. 10; Approval Withheld: Per ASA Report, source not approved for CSTC Miscellaneous Acceptance Criteria. Remarks • (PE): . Remarks (HQ): • DOT Form 350-071 Project Engineer Distribution Revised 03/2021 Q Contractor ❑Region Operations Engineer ❑Fabrication Inspection ❑Region Materials ❑State Materials Lab-MS 47365 � N WSDOT MATERIALS LAB 12/16/2021 Aggregate Source Approval Report Owner: Kangley Rock&Recycling,Black River Aggregate Source. -A-S'1 Lessee: Known as: Kangley Rock&Recycling, Black River Located in: T23N, RANGE4E, SECTION14 Section 14 T23N R4E County: King Remarks: Tier 1 & 2 Recycled Concrete Aggregates (RCA). Acceptance is based on Toxicity Test Report & Certification of Toxicity Characteristics per 9-03.21(1) & Field Testing for Grading, Sand Equivalency and/or Dust Ratio per 3-04 &9-03.See QPL for further info. (Mineral Agg.and Surfacing: Test Date: Expiration Date: Absorption: Apparent Sp.G.: Bulk Sp.G.(SSD): Bulk Sp.-G.: Deg: LA: • • Remarks: • • NOT approved as an aggregate source for: '\ T ast BST Crushed Cover Stone BST Crushed Screenings Crushed Surfacing Base Course Crushed Surfadng Key Stone • • Crushed Surfacing Top Course Gravel Backfill for Foundation Class A HMA Other Courses HMA Wearing Course Maintenance Rock Permeable Ballast • Aggregates for Concrete: Test,Date: Expiration Date: • ASR-14 Day: ASR-One Year: CCAAbsorption: CCA Sp.G: •Deg: FCA Absorption: FCA Organics: FCA Sp.G: LA: Remarks: • • • • NOT approved for: • Coarse Concrete Aggregates Fine Concrete Aggregates Riprap,Quarry Spells,Rock for Rock Wall,Erosion and Scour Protection: Test Date: Expiration Date: Absorption: Apparent Sp.G.: - Bulk Sp.G.(SSD): Bulk Sp.G.: Deg: LA: Remarks: NOT Approved for: Quarry Spalls Riprap Rock for Erosion and Scour Protection Rock for Rock Walls Stone 9-27.3(6) Streambed Aggregates: Test Date: Expiration Date: Absorption: Apparent Sp.G.: Bulk Sp.G.(SSD): Bulk Sp.G.: Deg: LA: Remarks: NOT Approved for: • Streambed Aggregate Streambed Aggregate Gravel Borrow for Structural Earth Walls: Test Date: Expiration Date: Bulk Sp.G.(SSD): Deg: LA: • NOT Approved for: Gravel Borrow for Str Earth Walls ALL OTHER PIT RUN MATERIALS:. • Project Engineer may request preliminary samples but Aggregate Source Approval is not required. AGGREGATE MATERIALS NOT REQUIRING ASA APPROVAL: Aggregate for Gravel Base 9-03.10 • Gravel Backfill for Foundation Class B 9-03.12(1)B Gravel Backfill for Walls 9-03.12(2) Gravel Backfill for Pipe Zone Bedding 9-03.12(3) • Gravel Backfill for Drains 9-03.12(4) Gravel Backfill for.Drywelis 9-03.12(5) Backfill for Sand Drains 9-03.13 Sand Drainage Blanket 9-03.13(1) Gravel Borrow 9-03.14(1) Select Borrow 9-03.14(2) Common Borrow 9-03.14(3) Native Material for Trench Backfill 9-03.15 Foundation Material Class A and B 9-03.17 Foundation Material Class C 9-03.18 Bank Run Gravel for Trench Backfill 9-03.19 • Commercial Concrete Aggregate 6-02.3(2)B PROJECT: Internal Testing DATE: 12/9/2021 LOCATION:BIackRiver--Quarry- SAMPLE SOURCE: A-516 SAMPLE DESCRIPTION: RCA 5/8" Crushed Surfacing Top Course (Type 1G) AGGREGATE SIZE: 5/8" TESTER: Sean SIEVE WEIGHT PERCENT PERCENT SPECIFICATION SIZE RETAINED RETAINED PASSING COS 9-03.9 3/4" 0.0 0 100 100 1/2" 0.3 3 98 80 - 100 3/8" 1.1 11 89 #4 3.5 35 65 46 - 66 • • #40 8.5 85 15 8 - 24 #200 9.9 99 2 0 - 10 PAN 10.0 100 0 WET SAMPLE: 10.4 TOTAL MOISTURE: 3.8% DRY SAMPLE: 10.0 S.E.: 62% FM: 1.20 FRACTURE % 95% DUST RATIO: 10% 'The minimum percent passing the No.50 and No.100 sieves may be reduced to 6 and 0,respectively,if the aggregate is to be used in air-entrained cencrote containing more than 400 lb of cement per cubic yard or in nonair-entrained concrete containing more than 500 lb of cement per cubic yard(0 33 6.2) , All � Washington State �!/ Department of Transportation Request for Approval of Material Contract Number FA Number •N/A SR Duvall Ave NE Date CAG 20-065 • Section/Title of Project Duvall Ave NE County King Contractor Reed Trucking & Excavating, Inc. Subcontractor • This form shall be completed prior to submittal. If this form is not compete at time of submittal it may For WSDOT Use Only • be returned for Information that was omitted. RAM# 060 { PE Use Bid Item ' Material or Name and Location of Fabricator, Specification PEIQPL I.-Mgt./QR. HQ Use No. Productfrype Manufacturer or Pit Number Reference Code Code A35 CSTC Kangley Rock & Recycling 4-04 1, 2, A44-52, 1175, B6-B9 ASA • • • • • { Project Engineer/Representative Date State Materials Englneer/Representative Date 12/20/2021 Acceptance Action Codes for use by Project Engineer and State Materials Laboratory 0Acceptance Criteria: Acceptance based upon"Satisfactory"Test Report for samples of materials to be incorporated into project. 2. Acceptance Criteria; Mfg.Cert.of Compliance for'Acceptance'prior to use of material. See Remarks. . Acceptance Criteria: Catalog Cuts for'Acceptance'prior to use of material.Catalog Cut Approved ❑Yes ❑No 4. Acceptance Criteria: Submit Shop Drawings for'Approval'prior to fabrication of material. 5. Acceptance Criteria: Only'Approved for Shipment'.'WSDOT Inspected'or'Fabrication Approved Decal'material shall be used. 6. Acceptance Criteria: Submit Certificate of Materials Origin to Project Engineer Office. 7. Acceptance Criteria` Request Transmitted to State Materials Laboratory for Approval Action. 9. Source Approved: 9. Approval Withheld: Submit samples for preliminary evaluation. 10. Approval Withheld: 11. Miscellaneous Acceptance Criteria. • Remarks (PE); Prior to use, provide toxicity testing and certification of toxicity characteristics in accordance with Section 9-03.21(1). Remarks rks, Provide Scale Cert. and Daily Scaleman's Reports. • Delivery Ticket shall show bid item number and description. DOT Form 350=071 Project Engineer Distribution. • Revised 03/2021 WrI Contractor Q Region Operations Engineer ❑Fabrication Inspection ❑Region Materials ❑State Materials Lab-MS 47365 PROJECT: Internal Testing DATE: 12/9/2021 LOCATION: Black River Quarry SAMPLE SOURCE: A-516 SAMPLE DESCRIPTION: RCA 5/8" Crushed Surfacing Top Course (Type 1 G) AGGREGATE SIZE: 5/8" TESTER: Sean SIEVE WEIGHT PERCENT PERCENT SPECIFICATION SIZE RETAINED RETAINED PASSING COS 9-03.9 3/4" 0.0 0 100 J 100 1/2" 0.3 3 98 80 - 100 3/8" 1.1 11 89 #4 . 3.5 . 35 65 4. .4.6 - 66 #40 8.5 85 15 4 . 8 - 24 • #200 9.9 .99 2 4 0 - .10- . PAN 10.0 100 0 WET-SAMPLE: 10.47__.._TOTAL MOISTURE:—._.___18%__.•_._.___.____,___..._..... • DRY SAMPLE: 10.0 S.E.: 62% 4 . FM: 1.20 FRACTURE %: . 95% J DUST RATIO: . ' • 10% 'The minimum percent passing the No.50 and No.100 sieves may,be reduced to S and 0,respectively,if the aggregate is to be used in air-entrained concrete containing more than 400 lb of cement por cubic yard or in nonairentrained concrete containing more than 500 ib of cement per cubic yard(C 33 6.2) W S DOT MATERIALS LAB 12/16/2021 Aggregate Source Approval Report Owner: Kangley Rock&Recycling, Black River Aggregate Source-A-5D Lessee: Known as: Kangley Rock&Recycling,Black River Located in: T23N, RANGE4E,SECTIONI4 Section 14 T23N R4E County: King Remarks: Tier 1 & 2.Recycled Concrete Aggregates (RCA). Acceptance is based on Toxicity Test Report & Certification of Toxicity Characteristics per 9-03.21(1) & Field Testing for Grading, Sand Equivalency and/or Dust Ratio per 3-04 &9-03.See QPL for further info. Mineral Agg.and Surfacing: Test Date: Expiration Date: Absorption: Apparent Sp.G.: Bulk Sp.G.(SSD): Bulk Sp.G.: Deg: LA: , Remarks: • • NOT approved as an aggregate source for: ATB Ballast BST Crushed Cover Stone BST Crushed Screenings Crushed Surfacing Base Course Crushed Surfacing Key Stone • Crushed Surfacing Top Course Gravel Backfill for Foundation Class A HMA Other Courses HMA Wearing Course Maintenance Rock Permeable Ballast Aggregates for Concrete: Test Date: Expiration Date: ASR-14 Day: ASR-One Year: CCA Absorption: CCA Sp.G: Deg: FCAAbsorption: FCA Organics: FCA Sp.G: LA: Remarks: NOT approved for: Coarse Concrete Aggregates Fine Concrete Aggregates Riprap,Quarry Spells,Rock for Rock Wall,Erosion and Scour Protection: Test Date: Expiration Date: Absorption: Apparent Sp.G.: Bulk Sp.G.(SSD): Bulk Sp.G.: Deg: LA: Remarks: NOT Approved for: Quarry Spells Riprap Rock for Erosion and Scour Protection Rock for Rock Walls Stone 9-27.3(6) Streambed Aggregates: Test Date: Expiration Date: Absorption: Apparent Sp.G.: Bulk Sp:G.(SSD): Bulk Sp.G.: Deg: LA: Remarks: NOT Approved for: Streambed Aggregate Streambed Aggregate Gravel Borrow for Structural Earth Walls: Test Date: Expiration Date: Bulk Sp.G.(SSD): Deg: LA: NOT Approved for: Gravel Borrow for Str Earth Walls ALL-OTHER-PIT-RUN-MATERIALS: Project Engineer may request preliminary samples but Aggregate Source Approval is not required., AGGREGATE MATERIALS NOT REQUIRING ASA APPROVAL: Aggregate for Gravel Base 9-03.10 Gravel Backfill for Foundation Class B 9-03.12(1)B Gravel Backfill for Walls 9-03.12(2) Gravel Backfill for Pipe Zone Bedding 9-03.12(3) Gravel Backfill for Drains 9-03.12(4) • Gravel Backfill for Drywalls 9-03.12(5) Backfill for Sand Drains 9-03.13 Sand Drainage Blanket 9-03.13(1) Gravel Borrow 9-03.14(1) Select Borrow 9-03.14(2) Common Borrow 9-03.14(3) Native Material for Trench Backfill 9-03.15 Foundation Material Class A and B 9-03.17 Foundation Material Class C 9-03.18 Bank Run Gravel for Trench Backfill 9-03.19 Commercial Concrete Aggregate 6-02.3(2)B ,;WSDCZ-Materials Laboratory https://www.wsdot.wa.gov/biz/mats/QPL/QPLProdinfo.cfm?Product_n... Washington State Department of Transportation Qualified Product List Product Information Manufacturer : Kangley Rock & Recycling, Black River, Renton - WA Product Name :.Tier 1 and Tier 2 - Recycled Concrete Aggregate (RS- A-516) Standard Spec : 9-03.21(1)C, Recycled Concrete Aggregate Product Description : Tier 1 and Tier 2 - Recycled Concrete Aggregate is approved for the following aggregate materials; 9-03.1(4) Coarse Aggregate for Commercial Concrete (Class 3000), 9-03.10 Aggregate for Gravel Base, 9-03.12(1)B Gravel Backfill for Foundations Class.B, 9-03.12(2) Gravel Backfill for Walls, 9-03.12(3) Gravel Backfill for Pipe Zone Bedding, 9-03.14(1) Gravel Borrow, 9-03.14(2) Select Borrow, 9-03.14(2) Select Borrow (greater than 3 feet below subgrade and side slope), 9-03.14(3) Common Borrow, 9-03.14(3) Common Borrow (greater than 3 feet below subgrade and side slope), 9-03.17 Foundation Material Class A and Class B, 9-03.18 Foundation Materials Class C, and 9-03.19 Bank Run Gravel for Trench Backfill. ********** For Tier 2 only - 9-03.9 Ballast and Crushed Surfacing; 9-03.12(1)A Gravel Backfill for Foundations Class A. See ASA for additional information. Product Restriction.: Need to provide toxicity testing and certification of toxicity characteristics in accordance with Section 9-03.21(1). Acceptance Code : 1175 Code Description : Acceptance is based on Toxicity Test Report and Certification of Toxicity Characteristics in accordance with Section 9-03.21(1) and Field Testing for Grading, Sand Equivalency and/or Dust Ratio in accordance with Sections 3-04 and 9-03. Last Updated : Sep 25, 2018 Contractors with WSDOT Click here for Contractor Product Info Page Copyright WSDOT© 2016 l of 1 12/20/2021,8:53 AM � Washington State -�S Department of Transportation Request for Approval of Material Contract Number. FA Number N/A SR Duvall Ave NE Date CAG 20-065 Section/Title of Project Duvall Ave NE County King Contractor Reed Trucking & Excavating, Inc. Subcontractor This form shall be completed prior to submittal.If this form is not compete at time of submittal it may For WSDOT Use Only j be returned for information that was omitted. RAM# 065 PE Use Bid Item Material or Name and Location of Fabricator, Specification PE/QPL Hdqtr./QPL HQ Use No. Product/Type Manufacturer or Pit Number Reference Code Code A35,A43A6" Tier 9-03.21(1)C 10 CSTC Squak Mountain A43.03.02 Bank Run Gravel for Trench Backfill 9-03.19 A52.03.02 Tier 1 Squak Mountain=Issaquah 9-03.21(1)C 1,2 • - Gravel Backfill for Pipe Zone Bedding 9.03.12(3) B6-B9 Tier 1 Squak Mountain-Issaquah 9-03.21(1)C 1,2 Project Engineer/Representative L- Date . State Materials Engineer/Representative Date 1/3/2022 Acceptance Action Codes for use by Project Engineer and State Materials Laboratory OAcceptance Criteria: Acceptance based upon"Satisfactory"Test Report for samples of materials to be incorporated into project. 0 Acceptance Criteria: Mfg.Cert.of Compliance for'Acceptance'prior to use.of material. 3. Acceptance Criteria: Catalog Cuts for'Acceptance'prior to use of material.Catalog Cut Approved 0 Yes ❑No 4. Acceptance Criteria: Submit Shop Drawings for'Approval'prior to fabrication of material: 5. Acceptance Criteria:-Only'Approved for Shipment','WSDOT Inspected'or'Fabrication Approved Decal'material shall be used. 6. Acceptance Criteria: Submit Certificate of Materials Origin to Project Engineer Office. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action. 8. Source Approved: 9. Approval Withheld: Submit samples for preliminary evaluation. 1l). Approval Withheld: Reclamation facility, must beon;the QPL as a Tier 2 facility, per WSDOT 9-03.21(1)C. 11, Miscellaneous Acceptance Criteria. See below QPL pages,Squak Mnt out of Issaquah is not Remarks currently an approved facility. (PE): Remarks Remarks: (HQ): Prior to use, provide toxicity testing and certification of toxicity characteristics in. accordance with Section 9-03.21(1). Provide Scale Cert. and Daily Scaleman's Reports. Delivery Ticket shall show bid item number and description. DOT Form 350-071 Project Engineer Distribution Revised 03/2021 J Contractor 0 Region Operations Engineer Q Fabrication Inspection 0 Region Materials 0 State Materials Lab-MS 47365 WSDOT-Materials Laboratory Qualified Products List(QPL) https://wsdot.wa.gov/biz/mats/QPL/QPLProductt-Grid.cfin 6•27: Washington State v// Dcpartmct of transportation Qualified Products List Standard Specification: 9-03.21(1)C Product Name _ IL_ Spec Title } Manufacturer _ _ __ Tier 1 and Tier 2 - Recycled f Recycled Concrete 'Central Pre-Mix (An Oldcastle Infrastructure ; Concrete Aggregate (RS-C-343) !Aggregate !Company), Spokane Valley-WA !Tier 1 and Tier 3 - RecyclediI Recycled Concrete ' (RS-B-352) Tucci and Sons, Lakewood-WA Concrete Aggregate ;Aggregate!Tier 1 and Tier 2 - Recycled ('Recycled Concrete 1 Kangley Rock & Recycling, Black River, I Concrete Aggregate (RS-A-516)_ ,Aggregate j Renton-WA Tier 1 - Recycled Concrete Recycled Concrete 1 j Aggregate (RS-F-211) Aggregate ,Cowden Gravel & Ready Mix, Bellingham-WA' Tier 1 - Recycled Concrete Recycled Concrete American Rock Products, Richland-WA j Aggregate (RS-R-189) Aggregate Tier 1 - Recycled Concrete I Recycled Concrete ! !Aggregate - ate !American Rock Products, Pasco-WA _ _ (RS —FN-121 A gg re gate Tier 1 - Recycled Concrete I Recycled Concrete I American Rock Products, Walla Walla-WA i Aggregate (RS-O-146) Aggregate , Tier 1 and Tier 3 - Recycled Recycled Concrete 'pro-Recycle, LLC, Spokane Valley-WA Conc rete Aggregate (RS-C-345) I Aggregate _ ? ; Tier 1 - Recycled Concrete ! Recycled Concrete j Holroyd Green Products Plant, Tacoma-WA !Aggregate (RS-B-351) I Aggregate I_ Tier 1 - Recycled Concrete Recycled Concrete IRenton Concrete Recyclers, Renton-WA Aggregate (RS-A-519) j Aggregate I Tier 1 - Recycled Concrete , Recycled Concrete Blake Sand &Gravel, Sequim-WA Aggregate (RS-Q-241) 1 Aggregate , Tier 1 - Recycled Concrete ; Recycled Concrete i Aggregate, RS-B-350 Aggregate (Dickson Company, Tacoma-WA j 'Tier 1 - Recycled Concrete ! Recycled Concrete Aggregate (RS-D-359) I Aggregate Lenz Enterprises, Inc., Stanwood-WA j Tier 1 - Recycled Concrete Recycled Concrete Corliss Resources, Inc., Puyallup-WA Aggregate (RS-B-349) Aggregate Tier 1 - Recycled Concrete Recycled Concrete Corliss Resources, numclaw-WA An regatr� DSO-A-5 8) Aggregate ; Inc.,/ . Tier 1 - Recycled Concrete ; Recycled Concrete IAction Materials, Inc. Spokane-WA Aggregate (RS-C-344) Aggregate ; Tier 1 and Tier 3 - Recycled : Recycled Concrete IFruhling Sand &Topsoil, Bothell-WA I Concrete Aggregate (RS-D-360) Aggregate — j Tier 1 - Recycled Concrete i Recycled Concrete if — i Aggregate (RS-OR-90) Aggregate I I.V. Riley, Bingden-WA Tier 1 and Tier 2 - Recycled j Recycled Concrete 1Stampede Sand & Gravel LLC, Easton-WA I Concrete Aggregate (RS-S_312)_ Aggregate � ___ Tier 1 and Tier 3 - Recycled Recycled Concrete Miles Resources - Lakeview, Lakewood-WA Concrete Aggregate (RS-B-353) Aggregate — _ —_____ I Tier 1 and Tier 3 - Recycled '(Recycled Concrete Concrete Aggregate RS-D-361 Aggregate i Reece Construction Company, Arlington-WA 1 of 2 12/29/2021,8:45 A1V ,WSDOT-Materials Laboratory Qualified Products List(QPL) https://wsdot.wa.gov/biz/mats/QPL/QPLProductsCind.ctm Tier 1 and Tier 3 - Recycled Recycled Concrete Girard Resources & Recycling LLC, Concrete Aggregate (RS-A-517) Aggregate Covington-WA Tier 1 and Tier 3 - Recycled Recycled Concrete Girard Resources & Recycling LLC, Concrete Aggregate (RS-D-358) Aggregate Snohomish-WA Tier 1 and Tier 2 - Recycled Recycled Concrete Interstate Concrete & Asphalt, Elk WA Concrete Aggregate (RS-C-346) Aggregate Tier 1 - Recycled Concrete Recycled Concrete Black Lake Resources, Littlerock-WA Aggregate (RS-J-217) Aggregate Tier 1 - Recycled Concrete Recycled Concrete Black Lake Resources, Grand Mound WA Aggregate (RS-J-216) Aggregate Tier 1 - Recycled Concrete Recycled Concrete Kitsap Reclamation & Materials, Bremerton- Aggregate (RS-I-118) Aggregate WA Copyright WSDOT© 2016 2 of 2 12/29/2021,8:45 AM ALLIANCE PO Box 80 Alliance Testing Services (tiSi TESTING Renton,WA 980566 `�-. SERVICES 425 757-0762 Plant 1-Alliance Testing Services Product 68-Squak Mountain CSTC Name/Title Mike Costello/Manager Period: 01/01/2019-04/09/2019 Report Date 04/09/2019 Procedure Sieve/Test Result Unit 9-03.9.3 Crushed Surfacing TC AASHTO T11/27 3/4"(19mm) 100.0 % 100-100 1/2"(12.5mm) 89.4 % 80-100 #4(4.75mm) 49.7 % 46-66 #40(0.425mm) 13.3 % 8-24 #200(75um) 7.60 % 0-10 AASHTO T176 SE 53 >40 AASHTO T335 Fractured Faces(>1) 86 >75 9-03.12(3)Gravel Backfill for Pipe Zone Bedding 9-03.19 Bank Run Gravel for Trench Backfill • Sieve Size i Percent Passing j Di" 99-100 I Saw Size Prircant• i" 75-100 JMIZI11111111111111111Eatini. iiH 50-100 J No.4 j 22-100 i No.4 20 80 1 No.200 0-10 No.40 3-24 I Dust Ratio: %max. No.200 10.0 max✓ Sand Equivalent 30 min. Sand Equivalent 35 min. StonemontQC Wi" Washington State Department of Transportation Request for Approval of Material Contract Number FA Number N/A SR Duvall Ave NE Date CAG 20-065 8/23/2021 _ Section/Title of Project Duvall Ave NE County King Contractor Reed Trucking & Excavating, Inc. Subcontractor Green City Inc. This form shall be completed prior to submittal.If this form is not compete at time of submittal it may For WSDOT Use Only be returned for information that was omitted. RAM#010 PE Use Bid Item Material or Name and Location of Fabricator, Specification PE/QPL Hdgtr./QPL HQ Use No. Product/Type Manufacturer or Pit Number Reference Cdde Code A69 Wood Chip Mulch Cedar Grove Compost;Maple Vallry,WA 8- 2.5;SP 9-14.5 3; 8 A35 CSTC Highrock D-309 9-03.9(3) 1 Project En sneer/Re ntative Date '^ State Materials Engineer/Representative Date A 8/ 47, ��`�v//---JJJ A c ce Ac 'n Codes for us by Project Engineer and State Materials Laboratory Occepta Criteria: Acceptance based upon°Satisfactoy Test Report for samples of materials to be incorporated into • project. 2. Acceptance Criteria: Mfg.Cert.of Compliance for'Acceptance'prior to use of material. 3. Acceptance Criteria: Catalog Cuts for'Acceptance'prior to use of material.Catalog Cut Approved ❑Yes ❑No 4. Acceptance Criteria: Submit Shop Drawings for'Approval'prior to fabrication of material. 5. Acceptance Criteria: Only'Approved for Shipment','WSDOT Inspected'or'Fabrication Approved Decal'material shall be used. 6. Acceptance Criteria: Submit Certificate of Materials Origin to Project Engineer Office. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action. 90 Source Approved: 9. Approval Withheld: Submit samples for preliminary evaluation. 10.Approval Withheld: 11. Miscellaneous Acceptance Criteria. Remarks (PE): Remarks (HO): DOT Form 350-071 Project Engineer Distribution Revised 03/2021 0 Contractor ❑Region Operations Engineer ❑Fabrication Inspection ❑Region Materials ❑State Materials Lab-MS 47365 Washington State �'/ Department of Transportation Request for Approval of Material Contract Number FA Number N/A SR Duvall Ave NE Date CAG 20-065 8/23/2021 Section/Title of Project Duvall Ave NE County King Contractor Reed Trucking & Excavating, Inc. Subcontractor Green City Inc. This form shall be completed prior to submittal.If this form is not compete at time of submittal It may For WSDOT Use Only be returned for Information that was omitted. RAM#010 PE Use Bid Item Material or Name and Location of Fabricator, Specification PE/QPL Hdqtr./QPL HQ Use No. Product/Type Manufacturer or Pit Number Reference Code Code Cedar Grove Compost;Maple Vallry,WA 8-02.5;SP 9-14.5 A69 Wood Chip Mulch (3); 8 A35 CSTC Highrock D-309 9-03.9(3) 1 Project Engineer/Representative Date State Materials Engineer/Representative Date Acceptance Action Codes for use by Project Engineer and State Materials Laboratory OAcceptance Criteria: Acceptance based upon"Satisfactory"Test Report for samples of materials to be incorporated into project. 2. Acceptance Criteria: Mfg.Cert.of Compliance for'Acceptance'prior to use of material. 3. Acceptance Criteria: Catalog Cuts for'Acceptance'prior to use of material.Catalog Cut Approved ❑Yes ❑No 4. Acceptance Criteria: Submit Shop Drawings for'Approval'prior to fabrication of material. 5. Acceptance Criteria: Only'Approved for Shipment','WSDOT Inspected'or'Fabrication Approved Decal'material shall be used. 6.. Acceptance Criteria: Submit Certificate of Materials Origin to Project Engineer Office. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action. i Source Approved: 9. Approval Withheld: Submit samples for preliminary evaluation. 10. Approval Withheld: 11. Miscellaneous Acceptance Criteria. Remarks (PE): Remarks (HQ): DOT Form 350-071 Project Engineer Distribution Revised 03/2021 12 Contractor ❑Region Operations Engineer ❑Fabrication Inspection ❑Region Materials ❑State Materials Lab-MS 47365 Medium grind Hemlock/Fir mix per Special Provision 8- 02.3(11) q,�,C� G,�o Cedar Grove Composting 2021 Letter of Certification Bark Mulch COI f00�STIiIG I 700%NATURAL www.cgcompost.com • 877-764-5748 This letter certifies that the Bark Mulch being used for the job referenced meets the following requirements. Company Name: Green City Job Reference: Duvall Ave NE 1. Cedar Grove Bark Mulch is derived from Douglas fir and Hemlock species. The mulch is screened so that a minimum of 95%will pass 1.5-inch sieve and no more than 55%will pass the% inch sieve. 2. This mulch is supplied by a fresh water mill; uniform in color and is free of sticks, roots, trash and other foreign material. 3. Mulch does not contain tannins, resin or other compounds in quantities detrimental to plant life. Please contact us is you have any questions. Sincerely, °"Y . Date: 8/13/2021 Kyle Sanders Cedar Grove Composting SUBMITTAL REVIEW 206-617-8736 X No Exceptions Taken Make Corrections Noted Amend & Resubmit Rejected-See Remarks IMPORTANT NOTICE:This review does not relieve the Contractor from responsibility to comply&conform with the Plans, Specifications, and Contract Documents. 4 iray&Osborne, Inc. CONSULTING ENGINEERS By: TLS Date: 8/25/21 Maple Valley-17825 Cedar Grove Rd.SE 98038 CIADt1AN High Rock HEIDELBERGCEMENTGroup Compliance Report Sample Information Sample No -1747752367 Product Id 92253 Product Name CSTC 60- Specification 9-03.9.3 Crushed Surfacing TC Date Sampled 12/03/2020 09:57 60- Sampled By Mario Necula I 5°- Sample Type Shipping Sample Method Belt-Stream Sample Location Highrock D-309 2C- 1C- 44, Tib Sieve Opening(mm) 010(B).012 060 156 1:60 4.91 D60.6.40 075+086.0.04 Co 5464 Cc:335 Gradation Results Quality Results Date Tested 12/03/2020 09:57 Tested By Mario Necula Sieve %Passing Tolerances Test Result Unit Tolerances Method 1 1/2"(37.5mm) 100.0 SE J 44 % _>40 AASHTO T176 1"(25mm) / 100.0 Grad Loss 0.009 % 3/4"(19mm) v 100.0 99-100 Total Moisture 2.11 % 5/8"(16mm) / 99.4 1/2"(12.5mm) J 90.0 80-100 3/8"(9.5mm) 78.0 1/4"(6.3mm) /59.3 #4(4.75mm) J 48.7 46-66 #10(2mm) /32.7 #40(.425mm) v/ 14.9 8-24 #200(75pm) J 8.31 0-10 StonemontQC 12/04/2020 Lehigh Materials Ltd. I F 0 WSDOT MATERIALS LAB 08/25/2021 Aggregate Source Approval Report Owner: Cadman Inc. Aggregate Source: QS-D-309 Lessee: Known as: High Rock Quarry-Quarry Rock Located in: W1/2NW1/4 Section 19 T27N R7E County: Snohomish Remarks: Mineral Agg.and Surfacing: Test Date: 02/25/2019 Expiration Date: 02/25/2024 Absorption: 1.61 Apparent Sp.G.:2.781 Bulk Sp.G.(SSD):2.704 Bulk Sp.G.:2.661 Deg:59 LA:18 Remarks: Currently approved as a source of aggregate for: ATB Ballast BST Crushed Cover Stone BST Crushed Screenings Crushed Surfacing Base Course Crushed Surfacing Key Stone Crushed Surfacing Top Course Gravel Backfill for Foundation Class A HMA Other Courses HMA Wearing Course Maintenance Rock Permeable Ballast Acceptance tests need to be performed as necessary. Aggregates for Concrete: Test Date: Expiration Date: ASR-14 Day: ASR-One Year: CCA Absorption: CCA Sp.G: Deg: FCA Absorption: FCA Organics: FCA Sp.G: LA: Remarks: NOT approved for: Coarse Concrete Aggregates Fine Concrete Aggregates Riprap,Quarry Spalls, Rock for Rock Wall, Erosion and Scour Protection: Test Date: 06/14/2021 Expiration Date: 06/14/2022 Absorption:1.36 Apparent Sp.G.:2.808 Bulk Sp.G.(SSD):2.742 Bulk Sp.G.:2.705 Deg:59 LA:17 Remarks: Currently Approved for: Quarry Spalls Riprap Rock for Erosion and Scour Protection Rock for Rock Walls Stone 9-27.3(6) Streambed Aggregates: Test Date: Expiration Date: Absorption: Apparent Sp.G.: Bulk Sp.G.(SSD): Bulk Sp.G.: Deg: LA: Remarks: NOT Approved for: Streambed Aggregate Streambed Aggregate Gravel Borrow for Structural Earth Walls: Test Date: 02/25/2019 Expiration Date: 02/25/2024 Bulk Sp.G.(SSD):2.704 Deg:59 LA: 18 Remarks: For geosynthetic reinforcement,the gravel borrow shall be tested for pH prior to placement. For metallic reinforcement,the gravel borrow shall be tested for pH, resistivity,chlorides,and sulfates prior to placement. If the resistivity of the backfill material equals or exceeds 5,000 ohm-cm,the specified chloride and sulfate limits may be waived. If the aggregate source has variable quality,additional testing may be required.Contact the Regional Materials Engineer or the State Geotechnical Engineer for direction. Currently Approved for: Gravel Borrow for Str Earth Walls ALL OTHER PIT RUN MATERIALS: Project Engineer may request preliminary samples but Aggregate Source Approval is not required. AGGREGATE MATERIALS NOT REQUIRING ASA APPROVAL: Aggregate for Gravel Base 9-03.10 Gravel Backfill for Foundation Class B 9-03.12(1)B Gravel Backfill for Walls 9-03.12(2) Gravel Backfill for Pipe Zone Bedding 9-03.12(3) Gravel Backfill for Drains 9-03.12(4) Gravel Backfill for Drywells 9-03.12(5) Backfill for Sand Drains 9-03.13 Sand Drainage Blanket 9-03.13(1) Gravel Borrow 9-03.14(1) Select Borrow 9-03.14(2) Common Borrow 9-03.14(3) I Native Material for Trench Backfill 9-03.15 Foundation Material Class A and B 9-03.17 Foundation Material Class C 9-03.18 Bank Run Gravel for Trench Backfill 9-03.19 Commercial Concrete Aggregate 6-02.3(2)B