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CAG-20-065 - Duvall - A83 - Cement Conc. Curb Ramp Type Parallel
Washington State 1r1 Department of Transportation Request for Approval of Material Contract FA Number SR Date CAG 20-065 2/28/2022 Section County Duvall Avenue NE Contractor Subcontractor Reed Trucking& Excavating,Inc. Concrete Services, Inc. This form shall be completed prior to submittal. If this form is not complete at time of For WSDOT Use Only submittal it may be returned for information that was omitted. For assistance in completing, see Instructions and Example RAM # 095 Bid Material or Name and Location of Fabricator, Specification PE/QPL Hdqtr./QPL Item No. Product/Type Manufacturer or Pit Number Reference Code Code A-82-83 Detectable Warning Pattern Armor Tile 8-14.3(5) 3 Project Engineer ,- Date State Materials Engineer Date L.� 8/31/2022' 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: 11.Miscellaneous Acceptance Criteria. Remarks: Project Engineer Distribution State Materials Engineer Distribution ▪Contractor ❑ Region Materials ❑ General File El Signing Inspection ❑ Region Operations Engineer ❑ State Materials Lab El Other ❑ Fabrication Inspection M/S 47365 DOT Form 350-071 EF Revised 12/2008 Armor Tile-ADA Truncated Domes-Products Armor-Tile' Tactile Systems SETTING THE STANDARD FOR QUALITY &DURABILITY IN DETECTABLE WARNING SURFACE ... I :,..fa Cast In Place Systems T_ • . . d/, • • • ... "�'f1'///i II"%1 \\ /> / . •;"-F///lit 1 ,I y\ \ '-- Or ■ Homo oYProaucts « Product Photos Colors Available • Cast In Place System Jr.'. 1 • Herculite Series .• 1.0 Replaceable Cast in Lill/ .�,� , `i, .� e ' . ,' ' Place �� • Surface Appliedas .... "' , Federal Yellow Ochre Yellow Brick Red System (Federal Color (Federal Color (Federal Color • Modular Paver System 4 ` I i f No.33538) No.23594) No.22144) • Detectable Guidance ------ - --` . System , Ai IMP.— , - • Detectable Directions 1 J1' - System -$. ..• tillt lie ilP Colonial Red Ocean Blue Onyx Black (Federal Color (Federal Color (Federal Color i Projects w No.20109) No. 15187) No. 17038) • ADA Regulations mow . SIOII . O Product Support • ■.o, IN Contact Dark Gray Light Gray Pearl White _., (Federal Color (Federal Color (Federal Color ■ Request a Quote AH No. 36118) No. 26280) No. 37875) ■ FAQs - ast In • ace ideos Detailed Cast In Place - ._. Drawings To download files right click and select Save Target As Part Number/ Adobe Autocad CAD Tile Size Reader (Zipped) Detail - -'+ ADA-C-1212 FDF El 'n ADA C 12125 • 5 12"x12" in ADA C 2424 FDF 'n / ADA C 24245 ciji NEI Click to View 1 24"x24" I ADA-C-2436 F'DF110 rn ADA C 24365FP 1E3 LE 1 24"x36" ADA-C-2448 FDF rn ADAC rig is 24"x48x48" ADA-C-2460 FDF rn ADA-C-2460S LE 24"x60" ADA-C-3648 FDF lEj 'a ADA-C-3648S , � `; 36 36"x48x48" Armor Tile-ADA Truncated Domes-Products Armor-Me /II 111 Click to View ADA-C-3660 FDF 'a ADA-C-3660S r �� Features: 36"x60" • lowest cost installation system Cast In Place Specifications available • certified to meet ADA and State Cast in Place ADA Compliant FGF requirements Specification Including Installation Instructions-PE/ • integral embedment flanges are the complete anchoring system F Advanced Warning Strip PDF ' • sustains dynamic vehicle loading, AASHTO HS20-44 wheel load test Cast In Place Installation • easily cut to conform to angled and radius ramps Instructions • sizes available; 12"x12", 24"x24", - • 24"x36", 24"x48 24"x60", Detailed Installation Instructions-PDF Fr.F Fig 36"x48", 36"x60" _ I • nine (9) standard colors Printable Illustrated Installation available with Federal Color Instructions PDF �,;,, identification Spanish Printable Illustrated • advanced warning strip - 3" X Installation Instructions-PDF 48", used to create a color — contrast around perimeter Illustrated Installation Instructions Cast In Place Radius Installation Video Advantage Cast In Place Tactile Warning System — 141 SUBMITTAL REVIEW 44 X No Exceptions Taken Make Corrections Noted Home Products Projects ADA Regulations Amend & Resubmit Support contact FAQs site map Rejected-See Remarks IMPORTANT NOTICE: This review does not relieve contractor from his responsibility to comply&conform with the Plans, Specification, and Contract Documents. Gray 'Osborne, Inc. CONSULTING ENGINEERS By: DRS Date: 8/31/22 aa.000• www.AffOr-TN.COM 1.050" 28 DOMES 0 1.670" 0/C 1.050" 3.00" 14 SPACES OUT TO OUT 0 3.00" 0/C 3.00" �BNCINB:RED PLASTICS ©2006 ENGINEERED PLASTICS co DETAIL-1 0.625" TYP. CONFIDENTIAL AND PROPRIETARY DOCUMENT cy \,/ _ ANY ONE ORYMRE OF THE FOLLOTNNG PATY A I1 U.S.PATENT NO.5,303,669,5,775,835, 6,449,790,AND 6,895,622 BS le. 00000000000000000000000000000 1 C.D.N.PATENT NO.2,032,532,2,070,984 U \ 0�'00000000000000000000000000 ••• .. .. '.: •• :: •• :: �•• •• :: " :: :: ::: p "0®000000000®00000000®0000000 :: _ _ _ _ _ _ _ _ . :: :: ::: US PATENTS E.SZEK •• :: :: O KENNEIH E.SZEKELY lc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O 0 O 0 0 0 0 0 0 0 0 0 0 0000000000000000000000000000 a o MATERIAL LIST �n ". 0000000000000000000000000000 °O # DESCRIPTION PART No: QT'Y 00 0 00 00 0 00 0 00 0 00 00 00 00 00 00 00 0 00 0 00 00 00 0 00 0 00 00 • _ _ _ _ _ _ _ _ _ _ _ _ _::+::_: 1 ARMOR-TILE ADA-0-2448-" 1 a 0co 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 p c o4 w B 0 0 00 00 0 0 00 0 00 0©0 00©0 0©0 000000 n _ g 000 00 00 00 0 0 0 00 0 00 0 00 0 0 0 00 0 0 0 0 00 0 0 0 1--,! _ ♦ 0000000000000000000000000000 a 00000000000000000000000000000000 _ _ _ _ _ _ _ _ _ 000000000000000000000000000000000 T YELLOW RCODRED RD, BLACK ;000@o0o0®Oooa®Oo000o000@0®0oE REFLECTED PLAN :1 :: :: .. :: :: :: ::. (VW), ( )) G), DARK GREY(DG), LIGHf GREY LG), -+ A n ( "=1"-O�"\ 0.625" 0.625" BLUEWHTTS(WH)COLONIAL RED (CR)), In PLAN (1 =1 —0 0.625" DIA. HOLES THROUGH / CUSTOM COLORS AVAILABLE EN N EMBEDMENT FLANGES 0.1875" DIA. x 0.0625" HIGH INTERNAL EMBEDMENT MICRO-TEXTURE UNDERSIDE OF TILE FLANGE 15 PER TILE In 1.050" 1.670" TYP. c, 1.2625• 1.670" TYP. 1.670" TYP. 1.2625" No: DATE REVISION APPR. I 1 r • ------- --- - 1 00000 • 000000000 • 000 M _ "�h 00000 • 000000000 . 000 Pail • moo. 00000 000000000 000 i 0000 0000 • •• 0 00 er 0.1875• DIA. VENT 0 0 0 0 0 • 0 0 0 OESOE' 0.1875„ 0.625" HOLE THROUGH EMBEDMENT HOLE (ONE PER 0 0 • 0 0 MN xs. 08/90 FLANGES AS SHOWN IN REFLECTED 0 •°o°o• 0 •000• rn D.G. 2/22/2006 PLAN CENTERED TYP. CELL EACH SIDE) O 0 000 2• 0 0 0 000 V. OWEDa SECTION A—A(1"=2") 000 r1,"/00000 o MEET MIXER ' 90 POINTS li 0000 0000000 00MIK ,,, 1.050" 1.670" TYP. 0.045" HIGH 0.1875" DIA. VENT 1.670" TYP. 1.050" 0000 * 000000000 0001, SABLE KARMIC SURFACE ADA-C-2448-" HOLE (ONE PER _ 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o VITRIFIED POLYMER COMPOSITE 0 o n 00000 000000000 000 � c`+ CELL EACH SIDE) �n co mom 0 0 0 00 O 0000000 00 , 0 0 0 00000 o Armor—Tile"ADA rr o 0 00 0 0 0 Opp I SOUND WARNING DETECEABLE/TACTILE - - W _ I 000 O\ 000 • " PROJECTL�� M0 0 0 _ 0 0 O Armor-T e- N0.09375" 0.093 o DETECTABLE/TACTILE 0 1875" 3.00" TYP. 3.00" - - NOTE: o WARNING SURFACE TILE 0.625" DIA. HOLE FIELD LEVEL EMBEDMENT FLANGES INTERNAL EMBEDMENT FLANGE NOTE:OPTIONAL 0.09375" 0.09375" 24" x 48" CAST IN PLACE 3.00" AS SHOWN IN 0 3" 0/C (SEE PLAN FOR SOUND AMPLIFYING 41CRO-T S PERE INLPL INE DOME TACTILE TILE REFLECTED PLAN ORIENTATION) PLATE ADDED BY DETAIL-1(FULL) S AR PER PLANS AND DETAILS "SECTION B—B(1"=2 ) MANUFACTURER SQUAREE INCH "�ADA-C-2448 0 0 ! i rWashington State 1 Department of Transportation Qualified Product List Product Information Manufacturer : Engineered Plastics, Inc., Williamsville - NY Product Name : Armor-Tile Cast in Place Standard Spec : 8-14.3(5) , Detectable Warning Surface Product Description': Detectable warning pattern; To be placed in fresh concrete; See Std Plan F-45.10 for futher details Product Restriction : Shall be used in fresh concrete only. Acceptance Code : 3106 Code Description : Visually verify the product delivered to the job site is the product that was originally submitted by the Contractor and approved from the QPL, and conforms to the dimensions as shown in the Contract Plans. If the detectable warning panel is steel and the Contract contains a Buy America clause the PEO is responsible for acquiring a Certificate of Material Origin from the Contractor. Last Updated : Dec 9, 2016 Contractors with WSDOT Click here for Contractor Product Info Page Washington State IV Department - , Re nest for Approval of Materiall Contract Number FA Number N/A SR Duvall Ave NE Date CAG 20-065 7/19/2022 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, RAW'# •084C PE Use Bid Item Material or Name and Location of Fabricator, Specification PEIQPL Hdgtr.IQPL HQ Use No. Product/Type Manufacturer or Pit Number Reference Code Code A73 WP40003 Cadman 1,2 A74-A77 A82-A84• Project Engineer/Representative Date State Materials Engineer/Representative Date 7/19/2022 Acceptance Action Codes for use by Project Engineer and State Materials Laboratory 10 Acceptance 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 ❑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: 11. Miscellaneous Acceptance Criteria. Remarks Mfr.Cert.of Compliance shall show cement mill test (PE): preport number and admixture product&dosage. Remarks (HQ): DOT Form 350-071 Project Engineer Distribution Revised 03/2021 ®Contractor ❑Region Operations Engineer ❑Fabrication Inspection ❑Region Materials ❑State Materials Lab-MS 47365 C ANL 117; Wishingten State Deparbinant at Transpasietteri Concrete Mix Design Contractor Submitted By Date Concrete Services Inc. Char 03/012022 Concrete Supplier Plant Location Cadman Inc. Issaquah(51) Contract Number Contract Name Duvall Ave NE Improvements This mix is to be used in the following Bid Item No(s): Concrete Class: 4000 V Remarks: WSDOT Class 4000 Air 4"+/- 1"Slump 6%+/- 1 5% Air Mix Design No. WP40003 - Plant No. 51 Cementitious Source Plant Type, Class or Grade Sp. Gr. Lbs/cy Materials /// Cement Lehigh I Delta, B.C. ASTM C 595 Type IL(15) ' I 3.15 470 V, Fly Ash a Boundary Dam Calgary,A.B. ® F ❑ C Alkali % 2.56 94 J GGBFS (Slag)a ❑ 100 ❑ 120 Concrete Admixtures Manufacturer Product Est. Range (oz/cy) Air Entrainment Master Builders MasterAir AE 901 0.25-10 Water-Reducing Type A n Master Builders MasterPozzolith 80�/ 1-40 Water-Reducing, High Range Type F n Master Builders MasterGlenium 7500 1-50 0 Water(Maximum) 245 Ibs/cy Is any of the water Recycled or Reclaimed? ❑Yesd ® No Water Cementitious Ratio(Maximum) 0.43 Mix Design Density(pcf) 145.6 Design Performance(Attach Test Data) Average 28-day compressive strength (psi) 6060 V-I Average 14-day flexural strength (psi) (Concrete Pavement Only) Concrete Chloride Ion Content(%by mass of cement) 0.022 ®Water Soluble ❑Acid Soluble Agency Use Only(Check appropirate Box) This Mix Design MEETS CONTRACT SPECIFICATIONS and may be used on the bid items noted above ❑This Mix Design DOES NOT MEET CONTRACT SPECIFICATIONS and is being returned for corrections Reviewed By: 'c . 7/19/2022 PE Signature Date DOT Form 350-040 EF Distribution: Original- Contractor Revised 05/2014 Copies To- State Materials Lab-Structural Materials Eng.; Regional Materials Lab;Project Inspector Mix Design No. WP40003 Plant No. 51 Aggregate Gradation ® AASHTO 0 Combined J Nominal Maximum Size (In) 1 V Aggregates 1 / 2 I 3 4 5 Total WSDOT Source No.b CA7 V A189 A189� Source Expiration Dateb 12/12/24 01/23/24 01/23/24 ASR Expansion (%)b ® 14 Day ❑ 1 Year 0.16% 0.36% 0.36% Is ASR Mitigation Required? No Yes Yes Stock Pile Grading c Class 2 AASHTO57AASHTO 8 , Percent of Total Aggregate 41 43 16 Specific Gravity(SSD) 2.65 2.73 2.72 Lbs/cy (ssd) 1253 1376 495 Include Percent Passing for each aggregate component. Include Total Percent Passing Total only for Combined Gradations. 2 inch 100 100 100 1-1/2 inch 100 100I/ 100 1 inch 100 1001 100 3/4 inch 100 90.3 100 1/2 inch 100 35.9✓ 100 J 3/8 inch 100 J 6.80 94.9 No. 4 99.1 ✓ 0.50 J 12.3 J No. 8 89.1 / 0.20✓ 1.10 ✓ No. 16 70.2 V 0.20 0.30 No. 30 46.5 0.20 0.30 No. 50 15.61 0.20 0.30 No. 100 3.601 V 0.20 0.30 No. 200 1.10 0.00 0.10 Fineness Modulus: 2.76 L(Re wired for Class 2-, d� �� .h__,�.�,��_,� -< , Proposed ASR Mitigation Method The use of Low Alkali cement Alt Method, see test result from ASTM C1567 Notes: \��_w \—...,\_x___x_ a Fly ash or GGBFS is required for Class 4000D and 4000P mixes. b Enter data from WSDOT ASA Database.ASR Mitigation is required for sources with 14-day expansions greater than 0.20%. No mitigation is required if the 1-year expansion is 0.04%or less. Proposed mitigation methods for 14-day expansions greater than 0.45%require ASTM C 1567 tests proving that the method is effective. See WSDOT Standard Specification 9-03.1. c Stockpile gradation:AASHTO No. 467, 57, 67, 7, 8;WSDOT Class 1, Class 2; or combined gradation stockpile sizes. See WSDOT Standard Specification 9-03.1. d Attach test results indicating conformance to Standard Specification 9-25.1. DOT Form 350-040 EF Revised 05/2014 L EHI GH EIEIDELBERGCEMENTGroup Lehigh Northwest Technical Services Report Number : C-17298 5225 E.Marginal Way South Date Cast : 06/17/20 Seattle,WA 98134 Customer: Cadman Inc. Phone:(206)763-2525 Mix # WP40003 F'c: 4000 PSI @ 28 Days 1 Cu.Yd. Specific Absolute Aggregate Batch Size Aggregate Ingredient SSD Wts. Gravity Volume Moistures 0.040 Moistures Cement(Lehigh Delta PLC) 470 3.15 2.39 1.007 19.00 lbs. 1"x#4 1D:# (08-28-19) 2.20 0.00 1.013 19.00 lbs. 3/8"x#8 Illifsh(BounANIFINPLss I 94 2.56 0.59 1.052 22.76 lbs. B.S.Mst. 01flk- I:.gala.Ss3iuth+.1 Jim.2112J)4. 2.71 0.00 0.00 22.76 lbs. 1"x#4 (Issaquah /A-189) 1376 2.73 8.08 1385.63 58.83 lbs. 3/8"x#8 (Issaquah /A-189) 495 2.72 2.92 . 501.44 21.76 lbs. 1.7 Fine Agg. 2.67 0.00 I 0.00 0.00 lbs. Bldg Sand (Sechelt/CA7) 1253 2.65 7.58 ! 1318.16 56.13 lbs. Fine Agg. 2.60 0.00 0.00 0.00 lbs. Water 245 1.00 3.93 167.15 6.69 lbs. Mbae-90 3.0 oz./yd. 1.63 0.12 3.5 cc. Pozzolith 80 22 oz./yd. 0.88 26.0 cc. MasterSet Delvo oz./yd. 0.00 0.0 cc. Glenium 7500 16.0 oz./yd. 0.64 18.9 cc. Total 3933 lbs. 27.11 157.5 lbs. Cale.Unit Wt. 145.09 Measured Slump 5.50 Air Temp. 70.7 W/C Ratio 0.43 Air Content 6.5 Unit Wt. 144.18 S/A Ratio(by weight) 40.1 Conc.Temp. 72.5 Yield 27.28 S/A Ratio(by volume) 40.8 Design Air Content 6.0%± 1.0 Target Slump 4.0"± 1.00" Area : 12.77 Cylinder Date Test Avg. Number Cast Date Age Size Pounds Psi Psi C-17298 06/17/20 06/20/20 3 4 x 8 45270 3550 "" 3 45370 3550 3550 06/24/20 7 58700 4600 7 58860 4610 4610 07/15/20 28 77730 6090 ',II 28 76760 6010 6060 "" 28 77800 6090 08/12/20 56 0 "" 56 0 0 Remarks: Bon/Peter. 90029111std C-17299 paperwork used for water and reporting. Mix batched with 2401bs/yd(6.501bs)water. TEST METHOD FOR DETERMINING THE E><IIMMIED POTENTIAL ALKALI-SILICA REACTIVITY OF COMBINATIONS OF CEMENTITIOUS MATERIALS ENGINEERING INC. AND AGGREGATE (ACCELERATED MORTAR-BAR) ASTM C-1567 Cadman Inc. Report Date: February 23, 2021 7554 185th Ave NE Project Number: 20-01608-010 Redmond,WA O552 Revision: Attention:Mr. John Cherne Sample: Fine Aggregate(A189) Source: A189 TEST NO: 20-01608-010 CEMENT TYPE: Type IL(EcoCem PLC) SAMPLED BY: Client CEMENT SOURCE: Lehigh Cement DATE SAMPLED: February-21 TOTAL CEMENT ALKALI: N/A SCM TYPE: Fly Ash Type F CEMENT ALKALI(Na2O eq.): 0.49% SCM SOURCE: Boundary Dam AUTOCLAVE EXPANSION: 0.03% SCM REPLACEMENT: 15% WATER BINDER RATIO: 0.47 D.30 r I I . — WSDOT 16-day Expansion Limit 025-- —a—Fine Aggregate(A189) " 0.20 MOM aZ z I g 0.15 c tl 0.10 0.05 - 0.00 i 0 2 4 6 8 10 12 14 16 18 TIME(Days) Ex ansion(%) TIME,Days_ 0 1 3 6 10 14 16 19 21 28 32 AVERAGE 0.000 - 0.030 0.070 0.110 - 0.180 - - - - WSDOT 16-day Expansion Limit 0.200 Notes: 1.Testing performed by accredited laboratory in accordance with ASTM C1567 and Concrete Reference Laboratory(CCRL)certification requirements.Accredited laboratory-Lafarge Seattle,5400 W Marginal Way SW,Seattle,WA 98106,USA 2.Average expansion of three(3)test specimens after 16 days is 0.18%which Is below the maximum expansion limit of 0.20%as per WSDOT. G. aIu Reported by: TM Reviewed by: I4/ Gene Lecuyer,P.Eng-Materials Engineer Results pertain only to the sarciple(s)provided end constitutes a testing service orgy,Engineering iterpretason or evaluation of the lest results will he provided upon written request only. EXL Engineering Materials Testing Lab, Unit#109-7198 Vantage Way,Delta,BC V4G 1 K7•PHONE 778-378-9054•EMAIL glecuyer@exlengineering.oam Aggregate Source Approval Report. Page 1 of 2 WSDOT MATERIALS LAB 06/11/2021 Aggregate Source Approval Report Owner: Construction Aggregates Ltd. Aggregate Source: PS-CA-7 Lessee: Lehigh Materials Ltd. Known as: Sechelt Pit Located in: Lot 288,Sechelt IR No.2,Group 1,New Westminster District Section-TN RW County: Canada Remarks: Mineral Agg.and Surfacing: Test Date: 11/20/2020 Expiration Date: 11/20/2025 Absorption:0.68 Apparent Sp.G.:2.747 Bulk Sp.G.(SSD):2.715 Bulk Sp.G.:2.697 Deg 75 LA:23 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: 12/12/2019 Expiration Date: 12/12/2024 ASR-14 Day:0.16 ASR-One Year: CCA Absorption: CCA Sp.G: Deg: FCA Absorption:0.87 FCA Organics:1 FCA Sp.G:2.666 LA: Remarks: Currently approved for: Fine Concrete Aggregates Acceptance tests need to be performed as necessary NOT approved for: Coarse Concrete Aggregates Riprap,Quarry Spalls, 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: https://wsdot.wa.gov/bizJmats/ASA/ASAReport.cfm?prefix=CA&pit_no=7 6/11/2021 Aggregate Source Approval Report. Page 1 of 3 WSDOT MATERIALS LAB 06/11/2021 Aggregate Source Approval Report Owner: Lakeside Industries Aggregate Source: PS-A-189 Lessee: Known as: Issaquah Pit Located in: N1/2 NW1/4 Section 27 T24N R6E County: King Remarks: Mineral Agg.and Surfacing: Test Date: 01/10/2019 Expiration Date: 01/10/2024 Absorption:0.98 Apparent Sp.G.:2.843 Bulk Sp.G.(SSD):2.793 Bulk Sp.G.:2.766 Deg:76 LA:14 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: 01/23/2019 Expiration Date: 01/23/2024 ASR-14 Day:0.36 ASR-One Year: CCA Absorption:0.91 CCA Sp.G:2.703 Deg:77 FCA Absorption:1.77 FCA Organics:2 FCA Sp.G:2.651 LA:13 Remarks: Currently approved for: Coarse Concrete Aggregates ASR MITIGATION MEASURES ARE REQUIRED PER WSDOT STD. SPEC. 9-03.1(1),WHEN USING AGGREGATE FROM THIS SOURCE FOR PORTLAND CEMENT CONCRETE.Acceptance tests need to be performed as necessary NOT approved for: Riprap,Quarry Spalls,Rock for Rock Wall,Erosion and Scour Protection: Test Date: Expiration Date: https://wsdot.wa.gov/biz/mats/ASA/ASAReport.cfm?prefix=A&pit_no=189 6/11/2021 National Ready Mixed Concrete Association Certificate of Conformance For Concrete Production Facilities NRMCATHIS IS TO CERTIFY THAT Issaquah Plant 51, Issaquah, WA Cadman, Inc. has been inspected by the undersigned licensed professional engineer for conformance with the requirements of the Check List for Ready Mixed Concrete Production Facilities. As of the inspection date,the facilities met the requirements for production by Central Mixing with Automatic Batching and Recordings of Cementitious Materials, Aggregate, Water, and Chemical Admixtures irG.84. olfw441.‘ (0 Signature of Licensed Professional Engineer Ve TEW � October 04, 2021 October 04, 2023 Inspection Date Certification Expiration Date This company will maintain these facilities in compliance with the Check List requirements and will correct promptly any deficiencies which develop. � ature C pany Official Title of Company Official p Y NOTICE:The Check List indicates only that plant facilities are satisfactory for the production of concrete when properly operated. Conformance of the concrete itself with specification requirements must be verified by usual inspection methods in accordance with sales agreements. This certificate is issued by the National Ready Mixed Concrete Association on verification that the production facility conforms to the requirements of the NRMCA Certification of Ready Mixed Concrete Production Facilities,QC3.Unauthorized reproduction or misuse of this certificate may result in legal action. Plant ID#: 801733 Certification ID#:28226 © 1965, 1992,2001,2002,2006,2007,2012 National Ready Mixed Concrete Assodation 66 Canal Center Plaza,Suite 250•Alexandria•Virginia 22314 Washington State �, Department of Transportation Request for Approval of Material Contract FA Number SR Date CAG-20-065 3/24/2022 Section County KING Duvall Ave NE Improvements Contractor Subcontractor Reed Trucking& Excavating, Inc. Concrete Services, Inc. This form shall be completed prior to submittal. If this form is not complete at time of For WSDOT Use Only submittal it may be returned for information that was omitted. For assistance in completing,see Instructions and Example RAM# 085B Bid Material or Name and Location of Fabricator, Specification PE/QPL Hdqtr./QPL Item No. Product/Type Manufacturer or Pit Number Reference Code Code Cure Compound- 1300 WR Meadows 9-23.2 8 Clear Sealtight Project Engineer C Date State Materials Engineer Date L L __ 3/24/2022 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 0 Yes 0 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. ()Source Approved: Use Lot#0B8003(shown on current QPL). Immediately notify if Lot no longer available. 9. Approval Withheld: Submit samples for preliminary evaluation. 10. Approval Withheld: 11.Miscellaneous Acceptance Criteria. Remarks: Project Engineer Distribution State Materials Engineer Distribution ISI Contractor ❑ Region Materials ❑ General File ❑ Signing Inspection ❑ Region Operations Engineer 0 State Materials Lab ❑ Other ❑ Fabrication Inspection M/S 47365 DOT Form 350-071 EF Revised 12/2008 Ps)`� ®� CT A DATA W. R. MEADOWS. SEAITIGHT "mimm zoo0=51 NIasterFormat:03 39 23 NO.372 JUNE 2013 (Supersedes July 2004) 1300-CLEAR Water-Emulsion, Wax-Based Concrete Curing Compound DESCRIPTION PACKAGING 1300-CLEAR water-emulsion, wax-based concrete curing compound is an excellent cure for 5 Gallon(18.9 L)Pails interior,exterior,horizontal,and vertical concrete 55 Gallon(208.2 L)Drums surfaces. When properly applied, the product COVERAGE provides a premium-grade which optimizes water Approximately 200 ft.2/gal.(4.9 m2/L). retention. 1300-CLEAR appears white in color when wet,but dries clear. It is also available with SHELF LIFE a red fugitive dye to visually aid application When stored indoors and in original, unopened coverage. containers at temperatures between 40-90°F(4- USES 32°C),shelf life is a minimum of two years from 1300-CLEAR can be used on interior,exterior, date of manufacture. horizontal,or vertical concrete applications, SPECIFICATIONS where subsequent surface treatments will not be • ASTM C 309,Type 1,Class A applied. (Type 1-D,also available) • AASHTO M 148,Type I,Class A FEATURES/BENEFITS (Type 1-D,also available) • When properly applied, provides a nearly • Missouri Department of Transportation: impermeable film which optimizes water Section 1055 retention. • Complies with all current federal,state,and • Furnished as a ready-to-use, true water-based local maximum allowable VOC requirements, compound. including U.S.EPA,LADCO,SCAQMD,and • Produces hard, dense concrete ... minimizes OTC. hair-checking, thermal cracking, dusting, and other defects. TECHNICAL DATA • Enhances the functional capabilities of VOC Content: 20 g/L concrete by"sealing in"the performance assets APPLICATION of strength and long life. • Offers a compressive strength significantly Surface Preparation ... Application equipment greater than improperly cured or uncured must be clean and free of any previously used concrete. materials. • Increases tensile strength for greater resistance Mixing ... For optimum performance, gentle to cracking and surface crazing mixing or agitation is recommended. • Improves resistance to abrasion and corrosive CAUTION: TO AVOID FOAMING, action of salts and chemicals ... minimizes DO NOT MIX EXCESSIVELY. shrinkage. • Applies quickly and easily with conventional, commercial spray equipment. • VOC-compliant. CONTINUED ON REVERSE SIDE... W. R. MEADOWS, INC. HAMPSHIRE, IL/CARTERSVILLE,GA,YORK, PA P.O.Box 338•HAMPSHIRE.IL 60140-0338 Phone:847/214-2100•Fax:847/683-4544 FORT WORTH,TX/BENICIA,CA/POMONA, CA 1-800-342-5976 GOODYEAR,AZ/MILTON,ON/ST.ALBERT. AB www.wrmeadows.com PAGE 2 ... 1300-CLEAR #372 ... JUNE 2013 Application Method ... 1300-CLEAR may be LEED INFORMATION sprayed on in one even coat with a hand or power May help contribute to LEED credits: sprayer, such as a Chapin 1949, as soon as the • ffiQ Credit 4.2:Low-Emitting Materials:Paints surface water disappears from horizontal concrete and Coatings • surfaces. On vertical surfaces, spray on promptly MR Credit 2:Construction Waste Management • after the forms are removed. Use a spray tip that MR Credit 5:Regional Materials produces a flow of .5 gal. (1.89 L) per minute under 40 psi(.276 MPa)of pressure. For most recent data sheet, further LEED information, and MSDS, visit Drying Time ... Depends on weather conditions «ti$.srmeado%.s.com. and coverage, but will generally dry in one hour. Restrict foot traffic for at least four hours. Twelve hours is preferable. Cleanup...Prior to drying,equipment may be 1,�& easily cleaned with soap and water.Once dried, use mineral spirits or other suitablepetroleum tnrrcnme.Perallyiformance or a n e p� �,c_' P kx Concrete PMonnan�ce distillate. PRECAUTIONS KEEP FROM FREEZING. Do not apply if the temperature of the concrete is less than 40° F (4° C). DO NOT MIX WITH CURES CONTAINING SOLVENT OR ADD SOLVENTS TO WATER-BASED CURES - SEPARATION WILL OCCUR. DO NOT ADD OR DILUTE WITH ANY OTHER COMPOUND. Do not use on concrete surfaces where paint, tile, or other treatments will be subsequently applied. HEALTH AND SAFETY Direct contact may result in mild irritation.Refer to Material Safety Data Sheet for complete health and safety information. LIMITED WARRANTY W.R. MEADOWS,INC.warrants at the time and place we make shipment,our material will be of - good quality and will conform with our published specifications in force on the date of acceptance `1 of the order. Read complete warranty.Copy furnished upon request. Disclaimer f The information contained herein is included for illustrative purposes only,and to the best of our knowledge,is accurate and reliable.W. R.MEADOWS,INC.cannot however under any circumstances make any guarantee of results or assume any obligation or liability in connection with the use of this information.As W.R.MEADOWS, INC.has no control over the use to which others may put its product,it is recommended that the products be tested to determine if suitable for specific application and/or our information is valid in a particular circumstance.Responsibility remains with the architect or engineer,contractor and owner for the design,application and proper installation of each product. Specifier and user shall determine the suitability of products for specific application and assume all responsibilities in connection therewith. ©W.R.MEADOWS 2004 06/13-4M •T State ifTransportation Qualified Product List Product Information Manufacturer : W.R. Meadows, Hampshire - IL Product Name : 1300-Clear Standard Spec : 9-23.2, Concrete Curing - Liquid Membrane-Forming Curing Compounds Product Description : Curing compound: Water base, wax base; Type 1, Class A; clear or translucent; Approved lot number (approved lots will be purged from the QPL Database at the end of the calendar year) - 0B8003 Product Restriction : Acceptance Code : 1115 Code Description : Receipt of a satisfactory Test Report from WSDOT Materials Laboratory is required indicating the lot(s) of material meets the requirements of the specifications under which it is listed. The Test Report must be received prior to incorporating the material into the project. Samples must be submitted to the State Materials Laboratory a minimum of 10 days prior to use. Note 4 : Approved lots do not require samples to be submitted. Last Updated : Jan 5, 2022 Contractors with WSDOT Click here for Contractor Product Info Page Copyright WSDOT© 2016 Use Lot#0B8003. Immediately notify if Lot no longer available. qiWashington State Department of Transportation Request for Approval of Material Contract FA Number SR Date CAG 20-065 3/22/2022 Section County DUVALL AVE NE Contractor Subcontractor Reed Trucking& Excavating, Inc. Concrete Services, Inc. This form shall be completed prior to submittal. If this form is not complete at time of For WSDOT Use Only submittal it may be returned for information that was omitted. For assistance in completing, see instructions and Example RAM# 084A Bid Material or Name and Location of Fabricator, Specification PE/QPL Hdqtr./QPL Item No. Product/Type Manufacturer or Pit Number Reference Code Code Cure Compound- 1100 WR Meadows 9-23.2 10 ,Clear Sealtight Project Engineer ty Date State Materials Engineer Date 3/28/2022 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 0 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: See RAM 085B for 1300 Clear with approved Lot#s 11.Miscellaneous Acceptance Criteria. Remarks: Project Engineer Distribution State Materials Engineer Distribution IX Contractor ❑ Region Materials ❑ General File ❑ Signing Inspection ❑ Region Operations Engineer 0 State Materials Lab ❑ Other ❑ Fabrication Inspection M/S 47365 DOT Form 350-071 EF Revised 12/2008 PRO D � (- 41 ® A A W. R. MEADOWS SEAITIGH1 .mom' Nl rFormat:03 39 23 NO.370 DECEMBER 2017 (Supersedes May 2016) 1100 Resin-Based, Water Emulsion Concrete Curing Compound DESCRIPTION • Minimizes excessive shrinkage. 1100 water-based concrete curing compound is • Can be applied quickly and easily with formulated from hydrocarbon resins and may be conventional commercial spray equipment. used on interior, exterior, vertical, and horizontal • Formulations also available with red fugitive concrete surfaces. Once applied, 1100 forms a dye added(Type 1-D). premium-grade membrane that retains an optimum • VOC-compliant. amount of water in freshly placed concrete for complete hydration of the cement. NOTE: After PACKAGING approximately four weeks, the membrane begins to 5 Gallon(18.93 L)Pails chemically break down when exposed to UV rays. 55 Gallon(208.20 L)Drums The membrane will eventually dissipate from the 275 Gallon(1040.99 L)Totes surface. This process is sped up by exposure to traffic and UV light, as well as weathering conditions. This product is formerly known as COVERAGE 1100-CLEAR. Approximately 200 ft.2/gal. (4.91 m2/L). Coverage is approximate and may vary depending USES on surface finish/texture, concrete condition, 1100 has been used on both interior and exterior climatic conditions, etc. Always apply to a test applications where paint, resilient tile, or resilient area first to determine actual coverage rate before flooring may be applied later. Because of the wide full-scale application. variety of coatings, paints, adhesives, and toppings available, contact the manufacturer of the flooring SHELF LIFE system or subsequent coating or topping for When stored indoors in original, unopcncd application approval over concrete cured with resin- containers at temperatures between 40° - 90° F based curing compounds. A small test application is (4 32 C), optimum performance and best use always recommended. is obtained within one year of date of manufacture. FEATURES/BENEFITS SPECIFICATIONS ■ When properly applied, 1100 produces a • AASHTO M 148,Type 1,Classes A&B premium-grade film, which optimizes water retention. (Type 1-D also available) • ASTM C309,Type I,Classes A&B • Furnished as a ready-to-use, true water-based (Type 1-D also available) compound. • Complies with all current federal, state, and • Produces hard, dense concrete ... minimizes hair local maximum allowable VOC requirements, checking, thermal cracking, dusting, and other including National EPA VOC Emission defects. Standard for Architectural Coatings, CARE, • Offers a compressive strength significantly LADCO,OTC Phase I and II,and SCAQMD. greater than improperly cured or uncured concrete. • Increases tensile strength for greater resistance to cracking and surface crazing. • Improves resistance to abrasion and the corrosive CONTINUED ON REVERSE SIDE... actions of salts and chemicals. ilk W. R. MEADOWS, INC. HAMPSHIRE,IL/CARTERSVILLE,GA/YORK. PA P.O.Box 338•HAMPSHIRE.IL 60140-0338 Phone:847/214-2100•Fax 847/683-4544 FORT WORTH,TX/BENICIA,CA/POMONA. CA 1-800-342-5976 GOODYEAR,AZ/MILTON,ON/ST.ALBERT.AB www.wrmeadows.com L. PAGE 2 ... 1100#370 ...DECEMBER 2017 TECHNICAL DATA PRECAUTIONS VOC Content by manufacturing location: KEEP FROM FREEZING. Do not apply if air AZ,CA: 42 g/L and/or concrete temperature is less than 40° F (4° IL,GA,PA,TX: 278 g/L C). Improper or over-application may increase the amount of time necessary for the film to dissipate APPLICATION from the surface. SURFACE MAY DISCOLOR Mixing ... For optimum performance,gentle mixing or AND/OR YELLOW DUE TO OVER- agitation is recommended. CAUTION: TO AVOID APPLICATION AND/OR MEMBRANE FOAMING,DO NOT MIX EXCESSIVELY. DO NOT OXIDATION. DO NOT MIX OR DILUTE WITH THIN. ANY OTHER PRODUCTS OR LIQUIDS. Do not apply paint, resilient flooring, or any other Application Method ... Application equipment must subsequent coatings or toppings without first be clean and free of all previously used materials. checking the specifications and securing approval Apply in a uniform film to horizontal surfaces as soon from the manufacturer of the product being applied as the surface water disappears and the surface will not over concrete cured with 1100. A small test be marred by walking workmen. On vertical surfaces, application is always recommended, prior to full- apply promptly after the forms are removed. 1100 may scale application. The 1100 membrane may take be applied with a typical commercial hand or power Ionger to dissipate if overapplied or has had limited sprayer,such as a Chapin 1949.Use a spray nozzle that exposure to UV light and environmental conditions, produces a flow of 0.5 GPM (1.9 LPM) under 40 psi etc. (.276 MPa) of pressure. An even spray pattern/application is essential to the aesthetic and final HEALTH AND SAFETY appearance of the concrete. Be mindful of clogged or Direct contact may result in mild irritation.Read and partially clogged spray tips that spray 1100 in an follow all application,precaution,label,and health and uneven and uniform pattern. Do not allow the spray safety information prior to use. Refer to Safety Data nozzle to drip on fresh concrete. Drips and uneven Sheet for complete health and safety information. spray patterns apply higher concentrations of the film, which may cause the cement to hydrate at different LEED INFORMATION rates. Removal of the film will not change the spray May help contribute to LEED credits: patterns mirrored in the concrete surface from the cement hydrating at different rates. • MRc9:Construction and Demolition Waste Management ■ EQc2: Low-Emitting Materials[For Healthcare and Drying Time ... Typically dries in 1 - 2 hours, Schools(exterior-applied products)ONLY] depending on jobsite conditions (temperature, % relative humidity, wind, etc.) Restrict foot traffic for at least four hours.Twelve hours is preferable. For most current data sheet,further LEED information,and SDS,visit'www.wrmeadows.com. Cleanup ... Prior to drying, cleanup can be accomplished with soap and water. Once dried, use mineral spirits or other suitable petroleum solvent. LIMITED WARRANTY W. R.MEADOWS,INC.warrants at the time and place we make shipment,our material will be of ' � good quality and will conform with our published specifications in force on the date of acceptance of the order.Read complete warranty.Copy furnished upon request. Disclaimer Jf'f o The information contained herein is included for illustrative purposes only,and to the best of our knowledge,is accurate and reliable. W.R. MEADOWS, INC. cannot however under any circumstances make any guarantee of results or assume any obligation or liability in connection with the use of this information.As W. R.MEADOWS,INC.has no control over the use to which others may put its product,it is recommended that the products be tested to determine if suitable for specific application and/or our information is valid in a particular circumstance. Responsibility remains with the architect or engineer,contractor and owner for the design,application and proper installation of each product. Specifier and user shall determine the suitability of products for specific application and assume all responsibilities in connection therewith. 0 W.R.MEADOWS 2017 12/17-500 V State Department of Transportation Qualified Product List Product Information Manufacturer : W.R. Meadows, Hampshire - IL Product Name : 1100-Clear Standard Spec : 9-23.2, Concrete Curing - Liquid Membrane-Forming Curing Compounds Product Description : Curing compound: Water base, resin cure; Type 1, Class A or B; Clear or translucent; Approved lot number(approved lots will be purged from the QPL Database at the end of the calendar year) - currently, none is approved. Product Restriction : Acceptance Code : 1115 Code Description : Receipt of a satisfactory Test Report from WSDOT Materials Laboratory is required indicating the lot(s) of material meets the requirements of the specifications under which it is listed. The Test Report must be received prior to incorporating the material into the project. Samples must be submitted to the State Materials Laboratory a minimum of 10 days prior to use. Note 4 : Approved lots do not require samples to be submitted. Last Updated : Jan 5, 2022 Contractors with WSDOT Click here for Contractor Product Info Page Copyright WSDOT©2016 Washington State fAdak � Deparbnent cd Thmsportation Request for Approval of Material Contract Number FA Number SR Date CAG 20-065 3/712022 Section!Title of Project .County Duvall Ave NE Improvements King Contractor Subcontractor Reed Trucking & Excavating, Inc. Concrete Services, Inc. This form shall be completed prior to submittal. If this form is not complete at time of For WSDOT Use OnI submittal it may be returned for information that was omitted. Y For assistance In completing,see Instructions and Example RAM# BEd Material or Name and Location of Fabricator, ' Specification PEJQPL HdgtrJQPL Item No. Product/Type Manufacturer or Pit Number Reference Code Code A-73 04C3A Miles Sand&Gravel 10 A.74-77 0442A Miles Sand & Gravel 2 Cement Type I/11 Ash Grove Seattle 9-01 2525- Fly Ash-Type GU & I-II Ash Grove 9-23.9 10 Air Entrainment Master AirAE90 Master Builders g-23 6(I) 2250 Water Reducer Type A Master Polyheedi 997 Master Builders 9-23.6(2) 2250 Course/Fine Aggregates PS-B-329 Canyon Road ASA Project Engineer. f — Date State Materials Engineer Date 3121i2022 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. e .•ptance 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','MOOT Inspected'or'Fabrication Approved Decal'material shall be used. 6.Acceptance Criteria: Submit Certificate of Materials:Cdgin to Project Engineer Office. 7.Acceptance Criteria: Request Transmitted to Slate Materials Laboratory for Approval Action. 8.Source Approved: 9. Approval Withheld: Submit samples-far preliminary evaluation. 0 Approval Withheld: Please note Class 3000 mix not allowed. Provide Mix Design on WSDOT form 350-040. 11.Miscellaneous Acceptance Criteria. Specify use for fly ash. Remarks: Mfr.Cert. of Compliance shall show cement mill test report number and admixture product&dosage.Mix No.0442A approved for use on BI 42. Project Engineer Distribution State Materials Engineer Distribution E1 Contractor ❑Region Materials ❑General File ❑Signing Inspection [j Region Operations Engineer ❑State Materials Lab ❑Other ❑Fabrication Inspection MIS 47365 DOT Form 350-071 EF Revised 1212012 4111 WWashington State AI Department of Transportation Request for Approval of Material Contract Number FA Number SR Date CAG 20-065 3/2/2022 Section/Title of Project County Duvall Ave NE Improvements King Contractor Subcontractor Reed Trucking & Excavating, Inc. Concrete Services, Inc. This form shall be completed prior to submittal. If this form is not complete at time of For.WSDOT Use Only submittal it may be returned for information that was omitted. For assistance in completing,see Instructions and Example RAM# 083 Bid Material or Name and Location of Fabricator, Specification PE/QPL Hdqtr./QPL Item No. Product/Type, Manufacturer or Pit Number Reference Code Code A-73 WPSLIP Cadman, Inc. 1,2 PM, A-82 4 WP40003 Cadman, Inc. 1,2 Cement Type IL (15) LeHigh, Delta B.C. 9-01 2525 . Fly Ash -Type F Boundary Dam, Calgary A.B. 9-23.9 2545 Water Reducer Type A Master Bu Idersh 80 9-23.6(2) 2525 Water Reducer Type F MasterGlenium 7500-Master Builders 9-23.6(1) 2525 Fine Aggregates CA7,D351,D336, Class 2 1,ASA Course Aggregates X125, A460,D351,D335,D336 ASSHTO 8,57 1,ASA Centralia Fly Ash 10 Plant 51 /Pit#A189 10 Project Engineer Date State Materials Engineer Date 3/21/2022 Acceptance Action Codes for use by Project Engineer and State Materials Laboratory E)11 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. See Remarks 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. ()Approval Withheld: Plant Issaquah (51)/Pit A189-ASR mitigation required. Cement Type IL (15) is not low alkali. 11.Miscellaneous Acceptance Criteria. Centralia Power Plant Fly Ash not shown on Mix Design. Remarks: Mfr.Cert.of Compliance shall show cement mill test report number and admixture product&dosage. Project Engineer Distribution State Materials Engineer Distribution ®Contractor ❑Region Materials ❑General File ❑Signing Inspection 0 Region Operations Engineer 0 State Materials Lab ❑Other ❑Fabrication Inspection M/S 47365 DOT Form 350-071 EF Revised 12/2012