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CAG-20-065 - Duvall - B21 - Furnish and Install 2-Inch Permanent Blow-off Assembly
• Alkik isurAw Washington State ir Department of Transportation Request foirAptOroval of Material, Contrad Number FA Minter NA SR - • • Date CA0 20-065 Duvall Ave NE , 0.1107f2922. • Section/Title of Project • County Duvall Ave NE King Contractor Subcontractor • Reed Trucking & Excavating, Inc. This form shall be completed Puerto submittal.If this form is not Cori-pate attfma of submittal it may For WSDOT Lila'Only be returned for-Information that was-omitted. RAM# 072 PE Use Blatant -Material or - time and Location of Fihrttator, Sperilcation PEJQPL lidqtiectPL HQ Use No. Product/Type Manufacturer or Pit Number Reference Code .Code B10 Thrust Blocks. „Ash,prove 7-16 ,2' • B9.113 `1312.02 1314.06 • 815.06 - • 816.06 817.10 • , • 81.0:10 " • .B19.00 1321.00 . . Project ErigInserfilepresentatiVa - Dale 1/1112922; State Materials EngineedRepnesentatiiie Date, . • • • Acceptance Action Codes for use by Project Engineer and State Materials Laboratory 1. ACCeptance Criteria! Acceptance based upon talisfactOn/Test Report for samples of materials te be Incorporated Into projecL 0 Acceptance criteria: Mfg.Cent of Compliance for'Acceptance'prior to use of material. 3. Acceptance Oriterkr• Catalog Cuts for Acceptance prior to use of Material..Catalog Cut Approved Yes 0 No 4, Acceptance Criteria: Submit Shop Drawings far'Approval'prier to fabrication of material. E.. Aoteptiance Criteria: Only'Approved for Shipment'.lArSOOTIrtspected'ret'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 forApprovat Action. . 8. SourceApproved: 9. Approval Withheld: Submit samples for preliminary evaluation. 10.Approval Withheld: 11. Miscellaneous Acceptance Criteria. Remarks (PE): Mfr. Cert. Of ComOilance-shall show cement iroilt test report nurnbeandadmixtOre product&dosage. Remarks • (HO): . 7-09.3(21) Concrete Thrust Blocking The Contractor shall prcivide the Engineer at least 1 Working Day advance notice before pouring concrete thrust blocking and 1 Working *Day advance notice for inspection and ) approval of all concrete blockirgzitLto backfilling. DOT Form 35E17071 Project Engineer Distribution Revised 03(2021 Conirector DRon Operations Engineer DFstiricai1cu rnspeStion Raglan Matadors Osiato Matafabi Lab-MS 47365 � Washington State II/ Department of Transportation Concrete Mix Design Contractor Submitted By Date Reed Trucking 1-7-2022 Concrete Supplier Plant Location Miles Sand&Gravel Pacific, Kent Contract Number. Contract Name Duvall Ave NE-Renton This mix is to be used in the following Bid Item No(s): Concrete Class: 4000 Remarks �/ Can be used for Commercial Class Concrete Mix Design No. 0442A Plant No..202.203V" Cementitious Source Plant Type,Class or Grade Sp.Gr. Lbslcy Materials Cement AshGrove Seattle ASTM C 1.50 Type till 13.15 564 Fly Ash a OFEIC Alkali% GGBFS(Slag)a ❑100ID 120 Concrete Admixtures Manufacturer Product Est Range (tufty) Air Entrainment BASF MasterAir AE90 1-15 Water-Reducing Type A BASF MasterPolyheed 997 17-50 Water(Maximum) 746 Ibs/cy Is any of the water Recycled or Reclaimed? Yesd Q No Water Cementitious Ratio(Maximum) 0.44 Mix Design Density(pcf) 144.8 Design Performance(Attach Test Data) Average 28-day compressive strength(psi) 5290 V Average 14-day flexural strength(psi)(Concrete Pavement Only) Concrete Chloride ion Content(%by mass of cement) .031 Q"Water Soluble. Acid Soluble Agency Use Only(Check appropriate Box) OX This Mix Design MEETS CONTRACT SPECIFICATIONS and may be used on the bid items noted above 0 This Mix Design DOES NOT MEET CONTRACTSPECIFICATIONS and is being returned for corrections Reviewed By: - -�s�'` 1/1112022 PE Signature Date DOT Form 350-040 Distribution:Original- Contractor Revised 01/2020 Copies To-"State Materials Lab-Structural Materials Eng.:Regional Materials Lab;Project Inspector i Mix Design No. 044.2A Plant No. 202,203 Aggregate Gradation Q AASHTO ['Combined Nominal Maximum Size(In) Edit... Aggregates 1 2 3 4 5 Total WSDOT Source No. b 8-329 J B-329 V Source Expiration Date b 06-2023\d/06-2023\/ ASR Expansion(%)b❑14 Day ❑✓ 1 Year 0.02 0.02 Is ASR Mitigation Required? NO NO Stock Pile Grading` 57 V CLASS 2\J Percent of Total Aggregate 0 Specific Gravity(SSD) 2.68 2.65 Lbs/cy(ssd) 1860 1260 3120 Include Percent Passing for each aggregate component. Include Total only Percent Passing Total for Combined Gradations. 2 inch 100.00 / 100.00 100.00 1-1/2 inch 100.00 V 100.00 100.00 1 inch 100.00 J 100.00 100.00 3/4 inch 78.00 / 100.00 86.88 1/2 inch 30.00 V 100.00 58.27 3/8 inch 8.00 /+ 100,00 J/ 45.15 No.4 0.10 V 98.00 V 39,64 No.6 0.10 J 84.20 r 34.06 No, 16 0.10 68.00 V 27.52 No.30 0.10 47.50 19.24 No.50 0.10 22,80 V/ 9.27 No. 100 0.10 5.10V 2.12 No.200 0.10 1.70 V 0.75 Fineness Modulus: 2,75 (Required for Class 2 Sand) Proposed ASR Mitigation Method: None Notes: a Fly ash or GGBFS is required for Class 4000P mix. 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 less than 0.04%.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 Distribution.Original- Contractor Revised 01/2020 Copies To-State Materials Lab-Structural Materials Eng. ;Regional Materials Lab;Project Inspector , vOFFICE:253.833.3705 FAX; 253,833.3746 400 Valley Ave NE Puyallup,WA 98372-2516 MILES SAND 8 GRAVEL Concrete Cylinder Report Concrete Mix ID: 0442A l AC1 318 Performance Approval I S..: 'd Site h: 4 000 Modification Factor' 1.000 Number of Tests: 30 Standard Deviodon: 636 Average Range(PS!): 178 , Per.Fe 41.34(s): 4,852 Standard Deviation: 636 Fcrz Fe+2.330)-500: 4,981 coefficient of Variation,v: 9.2% l+ Within-Test Std Oev(P51): 158 \/ Within-Test Coeff.of Vat 2.3% Average 4.82 4.7 /0 67 53 4,220 5,290 Botch-to-Batch Sid Dev(PSi): 616 Max: 6.75 7,0% 7,N 72 5,42o 6,M?0 Batch-to-Batch Caeff of Var 8.9% min: 3.50 0.0% 59 3 7 2,89i1 4,060 Date Slump Air CT AT 7 Day 28 Day 1 06/24/21 5.75 5.0% 75 63 3,880 4,980 2 06/22/21 5.25 5.0% 78 70 4,370 5,370 3 03/25/21 4.00 5.5% 70 47 4,120 5,430 4 03/05/21 4.50 5.3% 65 50 4,310 6,050 5 03/02/21 6.00 4.0% 60 43 3,970 5,400 6 02/24/21 6,75 7,0% 62 37 2,890 4,080 7 01/27/21 4,50 7.0% 60 45 3,850 4,880 8 01/06/21 4.50 5.1% 61 45 5,170 5,990 9 12/23/20 4,50 5.0% 63 41 3,980 5,300 10 12/17/20 4.00 5.5% 59 47 5,030 5,870 11 11/23/20 4.50 5.0% 64 41 4,200 5,090 12 11/09/20 5.25 5.5% 63 43 5,420 6,890, 13 08/20/20 5.00 4,2% 78 63 4,140 5,280 14 08/05/20 4.25 4.6% 64 64 3,230 4,290 15 07/31/20 5.50 3.5% 78 59 4,120 4,920 16 07/28/20 6.00 5.5% 72 70 3,360 4,060 17 06/19/20 4.50 4,5% 76 72 3,510 4,400 18 06/18/20 4.00 4,2% 71 70 4,090 5,250 19 06/09/20 5.50 6,0% 68 54 3,740 4,710 20 06/09/20 5.00 6.0% 69 57 4,490 5,850 21 06/04/20 4.00 5.3% 63 60 4,690 5,560 2: 06/02/20 450 5.1% 67 54 3,810 4,800 23 05/20/20 4,00 4.9% 70 52 4,130 5,570 24 05/06/20 5.00 5.1% 63 54 4,330 5,230 23 04/22/20 5.00 5.2% 67 52 4,930 6,090 215 04/20/20 3.50 64 52 4,970 5,690 27 02/17/20 5.00 66 43 4,690 5,830 Jx 02/17/20 4.25 68 46 4,890 5,770 2'i 02/03/20 5.00 4.9% 65 44 4,120 5,140 30 01/24/20 5.00 5.6% 64 50 4,210 4,950 Miles Sand & Gravel Company WWW.MILES.R0CKS DBASF The Chemical Company CHLORIDE ION CONTENT ESTIMATOR OUTPUT Customer/Plant: Comments: Mix ID/Number. 0442A Application: ( AMOUNT CHLORIDE ION CHLORIDE ION MIX INGREDIENT CONTENT CONTRIBUTION (Iblyd3) (%by Mass) (Ib/yd3) CEMENT 564 0.0050 0.0282 FLY ASH 0 0 0010 SILICA FUME(RHEOMAC SF 100) SLAG CEMENT FINE AGGREGATE 1270 0.007 0.0889 COARSE AGGREGATE#1 1860 0.0050 0.0930 COARSE AGGREGATE#2 0 0 0050 WATER 246 10 (ppm) 0.0025 CHLORIDE ION ADMIXTURE TYPE PRODUCT NAME DOSAGE CONTRIBUTION (Ib/Yd3) AIR-ENTRAINER: MB AE 90 0 75 1 (fl oz/cwt) 0.0003 ACCELERATOR j (fl oz/cwt) RETARDER: J (fl oz/cwt) WATER REDUCER: 1 (fl oz/cwt) MID-RANGE WR: POLYHEED 997 6.0 (fl oz/cwt) 0.0042 HIGH-RANGE WR: (fl oz/cwt) WORKABILITY RETAINER: (fl ozJcwt) VISCOSITY MODIFIER: (fl oz/cwt) ASR INHIBITOR: (gal/yd3) CORROSION INHIBITOR: (gal/yd3) SHRINKAGE REDUCER: (gallyd3) -COLOR: (Ib/cwt) WATERPROOFING: J I (Ib/cwt) TOTAL CHLORIDE ION CONTENT OF CONCRETE(Ib/yd ) = 0.217 CHLORIDE ION CONTENT(%of Concrete) = 0.006 W-S CHLORIDE ION CONTENT(%of Cement) = 0.031 W-S CHLORIDE ION CONTENT(%of Total Cementitious Materials) = 0.031 T j no BASF 30 00 Cast-in-Place Concrete We create chemistry 3 s 40 00 Precast Concrete 03 70 00 Mass Concrete MasterAir® AE 90 Air-Entraining Admixture Formerly MB-AE 90" Description Features MasterAir AE 90 air- • Ready-to-use in the proper concentration for rapid,accurate dispensing entraining admixture is for use in concrete mixtures. It Benefits meets the requirements of ASTM C 260, AASHTO M ■ Improved resistance to damage from cyclic freezing and thawing 154 and CRD-C 13. ■ Improved resistance to scaling from deicing salts ■ Improved plasticity and workability Applications ■ Reduced permeability-increased watertightness Recommended for use in: • Reduced segregation and bleeding • Concrete exposed to cyclic freezing Performance Characteristics and thawing Concrete durability research has established that the best protection for concrete from the ■ Production of high-quality adverse effects of freezing and thawing cycles and deicing salts results from: proper air normal or lightweight content in the hardened concrete, a suitable air-void system in terms of bubble size and concrete(heavyweight spacing,and adequate concrete strength,assuming the use of sound aggregates and proper concrete normally does mixing,transporting,placing,consolidation,finishing and curing techniques.MasterAir AE 90 not contain entrained air) admixture can be used to obtain adequate freeze-thaw durability in a properly proportioned concrete mixture, if standard industry practices are followed. Air Content Determination: The total air content of normal weight concrete should be measured in strict accordance with ASTM C 231, "Standard Test Method for Air Content of Freshly Mixed Concrete by the Pressure Method' or ASTM C 173/C 173M. "Standard Test Method for Air Content of Freshly Mixed Concrete by the Volumetric Method,"The air content of lightweight concrete should only be determined using the Volumetric Method. The air content should be verified by calculating the gravimetric air content in accordance with ASTM C 138/C 138M, "Standard Test Method for Density(Unit Weight), Yield, and Air Content (Gravimetric) of Concrete." If the total air content, as measured by the Pressure Method or Volumetric Method and as verified by the Gravimetric Method, deviates by more than 1.5%,the cause should be determined and corrected through equipment calibration or by whatever process is deemed necessary. MASTER' »BUILDERS SOLUTIONS MasterAir AE 90 Technical Data Sheet • Guidelines for Use Precaution Dosage: There is no standard dosage for MasterAir AE 90 In.a 2005 publication from the Portland Cement Association admixture.The exact quantity.of air-enti-aining'admixture needed (PCA R&D Serial NO, 2789), it was reported that problematic for a given air content of concrete varies because,of differences air-veld GI uste ri n g that can potentially lead.to above barns] in concrete making matenals end ambient conditlens. Typical .decreases in strength Was found to coincide with late additions of factors that might influence the amount of air entrained include: water to air concretes Late additions of water include terriPerature, cementitidus- nriateriala, send. gradation, sand- the conventional practice of holding back water during batching aggregate ratio,mixture proportions,slump,means 9f conveying for addition at the tobSite.Therefore,caution be exercised .and placement, consolidation and finishing technique The with delayed additions of water to air-entrained 'concrete'. amount of IVIaaterAir AE 90 admixture used will depend upon Furthermore, an air content check should be performed after emount of entrained air required under actual job,conditions. post-batching addition of any other materials to an air-entrained In.a trial Mixture, use 0.25 to 4 fl oz/cwt (16=250 mLild0 kg) concn3termixture. of cementitious material..Measure the air content of the trial mixture,and,if needed;either increase or decrease the quantity Product Notes of MasterAir AE 90 admixture to obtain the desired air content. CorroSitrity — Non-Chloride, Non-Corrosive: MasterAir AE 90 In mixtures containing water-reducing or set-controladmixtures, admixture- will neither initiate nor promote corrosion Of the amount of MasterAir AE 90 admixture needed may be 'reinforcing and prestressing steel embedded In cbrtcrete,ser somewhat less than the amount required In plain concrete: of galvanized floor and roof.Systems. No calcium.chloride or Due to.possible changes in the factors that can affect the other Chloride-based ingredients are used in the manUfactbre dosage of MasterAir AE 90 admixture, frequent air content of this adrnixture. checks should be made during: the course of the work. Compatibility: MasterAir AE 90 admixture MAY be used ih 'Adjustments to thadosage.ahould be based on the.amount of combination with.any BASF admixture, unleGe stated otherwise entrained air required in the Mixture:at the point of placement. on the Cate sheet for the other product.When used in conjunction If an unusually high or low dosage of MasterAirAE 90 admOdure with other aditiktures, each admixture must be dispensed is required to Obtain the desired air content,,consult your food separately into theconcrete mixture: sales representative, In such,cases,, it may be necessary to determine that, in addition to a proper air content in the fresh Storage and Handling concrete,.a Sultablealr-Vold system is achieved in the hardened Storage Temperature:MasterAirAE 90 admixture shciuld be stored concrete: and dispensed at 3,1°F(40.5°C),or higher.Althqugh freezing dOes Dfspeniing and Mixing: Add MasterAlr AE'90 admixture to the notharrnthiSProokiet,Precautions shouldbetakentoprOtectitirom concrete mixture using a dispenser designed for eirentraining freeiing.if MasterAirAE90 adrnbcture freeieS,thaw at 35°F(2 gq admixtures,or add manualty using a suitable measuring de ice or above andcorripletely reconstitute by mild macharileal agitation. that ensures accuraCy within Ius or Minus 3%of the required Do not use pressurized air for agitation. amount. Shelf Life: MasterAir AE 90 admixture has a minimum-shelf Foroptinium,consistent perfOrmance,the eir-entraIning admixture life of 15 Months. Depending on storage conditions,the shelf should be dispensed.Oh derv,.fine aggregate. If the concrete life may be greater than stated. Please contact your local mixture contains fine lightweight aggregate, field evaluations sales representative regarding suitability for use.and.dosage should be conducted to determine the best method to dispense 'recommendations if the shelflife of MasterAir AE.90 admixture the air-entraining admixture. has been exceeded. Safety:Chemical goggles and gloves arorecommended when transferring or handling this material. BASF Corporation Admixture Sysjems www.nnatter-builders-solutions.basf.us page 2 of 3 MasterAir AE 90 Technical Data Sheet Packaging Limited Warranty Notice MasterAir AE 90 admixture is supplied in 55 gal(208 L)drums, BASF warrants this product to be free from manufacturing 275 gal(1040 L)totes and by bulk delivery. defects and to meet the technical properties on the current Technical Data Guide, if used .as directed within shelf life. Related Documents Satisfactory resulta depend not only on quality products but Safety Data Sheets: MasterAir AE 90 admixture also upon many factors beyond our control. BASF MAKES NO OTHER WARRANTY OR GUARANTEE, EXPRESS OR IMPLIED, INCLUDING WARRANTIES OF MERCHANTABiUTY Additional information OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT For additional information on MasterAir AE 90 admixture,or its TO ITS PRODUCTS. The sole and exclusive remedy of use in developing a concriete mixture with special peformance Purchaser for any claim concerning this product,including but characteristics,contact your local sales representative. not limited to, claims alleging breach of warranty, negligence, The Admixture Systems business of BASF's Construction strict liability or otherwise,is shipment to purchaser of product Chemicals division is the leading provider of solutions that equal to the amount of product that fails to meet this.warranty improve placement, pumping, finishing, appearance and or refund of the original purchase price of product that performance characteristics of specialty concrete used in fails to meet this warranty, at the sole option of BASF. Any theclaims concerning this product must be received in writing ready-mixed,precast;manufactured concrete products, underground 'construction and paving markets. For over within one(1)year from the date of.shlpment and any.clairns 100 years we have offered reliable products,and innovative not presented within that period are waived by Purchaser. technologies, and through the Master Builders Solutions BASF WILL NOT BE RESPONSIBLE FOR ANY SPECIAL, INCIDENTAL CONSEQUENTIAL(INCLUDING LOST PROFITS) brand, we am connected globally with experts from many fields to provide sustainable solutions for the construction OR PUNITIVE DAMAGES OF ANY KIND. industry. Purchaser must determine the•su'itabirrty of the products for the intended use and assumes all risks and liabilities in cgnrrectibn therewith. This information and all further technical advice are based on BASF's present knowledge and experience.However, BASF assumes no liability for providing such information and advice including the extent to which such information and advice may relate to existing third party intellectual property rights, especially patent rights, nor shall any legal relationship be created by or arise from the provision of such information and advice. BASF reserves the right to make any changes according to technological_progress or further'developments. The Purchaser of the Product(s) must test the.product(e) for suitability for the intended application and purpose before proceeding with a full application of the produdt(s)..Performance of the product descry-bed herein should be verified by testing and carried out by qualified experts. NSF. `1619-AE 50 beam=MxsterA•r AE 90 under the Master Builders Soho iums brand,offeciivo January 1.2014. ,r= e 8ASF Corperatlon 2016■01/1 S u PRE-0AT 0013 Corporation united Sty Canada BASF[UCE Systemsoratio23703 Chegin B�tievand ieC0 Clark Boulevard AdmixCleveland,Olio,4122.56.44 Brampton.Ontario LOT 4M7 www.master-builders-solutions.basf us Tyr &CO 628.930 r Fax 2113 630.8221 Tel;BOO 387.5t 622 a Fax-,935 792.13651 page 3 of 3 Engineer Addition LA/ashington State Department of January 10,2022 Qualified Product List Contractor Product Information Contractor: Contract No:1 Sub Contractor: Date: Bid Item: Manufacturer: BASF Corporation (formerly BASE Construction Chemicals, Inc.) Cleveland. OH Product Name: MasterAir AE 90 Standard Spec : 9-23.6(1),.Concrete Admixture - Air Entraining Admixtures Product Description : Liquid air entraining admixture for concrete Product Restriction : Acceptance Code: 2250 Code Description : Acceptance is by field verification and the retaining of the Concrete Producer`s Certificate of Compliance indicating the product and dosage of the admixture conform to the concrete mix design. Last Updated : Nov 27, 2013 To be completed by the field inspector: Quantity: Verified Br Date: D BASF 1030 00 Cast=in-Place Concrete 03 40 00 Precast Concrete We create chemistry 3 03 70 00 Mass Concrete MasterPolyheed® 997 Mid-Range Water-Reducing Admixture Formerly PolyHeed 997* ;`Description, Features Masteiftlyteed,997' ® True mid-range water reduction(5-15%)and excellent performance across a wide slump 'admixture is'a:,patented range, especially the difficult slump range of 5-8 iri, (125-200 mm) ."m�ul'ti=i n�apo ent,mild=•, + 4_M f "�• In Superior workability, pumpability and finishability.qualities even in concrete mixtures range water-rediacirig containing low amounts of cementitious materials admixture Ma.; ste Polyheecl 997;adrmxir eirrieets a Superior finishing characteristics for residential/commercial flatwork and formed surfaces ASTM C:.4944941VII "' .. Benefits , requiremeetafor zyr`�erA;• water=reducing;:and-Type;F. • Significantly reduced placement and finishing time resulting in lower in-,place 'i=lii h-ranga-maer-reducing, concrete costs admixtures: ".. i Higher strength,at all ages 'Applications;,: ' in Enhanced concrete durability `„i �° i(° "' ■ Increased service life of concrete structures Recommended'- 'use In'. ' ■°All°ceiricretWiPlicati_ores 061.6ruaei§i, ,.. `u Performance Characteristics workablity,:,purnpability Mixture Data:500 lb/yd3(295 kg/m3)of Type I cement;slump 6-7 in.(150-180 mm);5-6%air; a rid ifnlst ability qualities concrete temperature 70°F(21 °C);ambient temperature,70°F(21 °C). , 'are.desir._ed;wn partic clar,9 setting Time Performance' 'fat o c pumped ' cc�riecete,eii .p®riiioias4'' Initial Set Difference concrete _.....+-_..... h......°}......_-_-....--__..-.._-.....(h:m n) Mixture •.m r r a Concretecpntaining, Reference _...._.._.._..+._ _......_._.._._...�..._.� 6:01 �.._.—._.+._..._._.. _.._.._._... f +manufactured=sand and MasterPolyheed 997 admixture© harshrconcrete!mrllifures 5 floz/cwt(325 mU100.kg) 6:22 +0:21 10 fl oz/cwt(650 mU100 kg) 6:57 +0:56 ' 15 fl oz/cwt(980 mU100 kg) 7:31 +1:30 C 1 - MASTER° >>BUILDERS w SOLUTIONS MasterPolyheed .997 Technical Data Sheet Compressive Strength,psi(MPa) Storage and Handling Mixture 7-Day 28-Day Storage Temperature:If MasterPolyheed 997 admixture freezes, Plain 2360(16.3y 3320(22.9)• t•haw at 35 °F (2 °C) or above and completely reconstitute ........ .......�.,,..,..._......,,,•.y_, by mild mechanical agitation. Do not use pressurized.air for MasterPolyheed 997 admixture agitation. 5 fl ozlcwt(325 mU100 kg) 3060(21.1) 3930(27.1) Shelf Lite: MasterPolyheed .997 admixture. has :a minimum TO ft ozfcwt(650 mU100.kg) 3740(25 8) 4610(31,B) shelf life of 18 months; ❑epending on storage.conditians, the 15 fl ozkwt(980 mU100 kg) 4620(31:9) 5460(37.7) shelf fife may be greater than stated:Please contact your local Note: The data shown ara based on coat o ed laboratory, feels._ sales •representative regarding suitability:for,.use and dosage Reasonable variations from the-results slows here maybe experienox recommendations if the shelf life of MasterPolyheed 997 as a res itt of'ditrorences M cot Crete making materials and jobsite admixture has been exceeded. condiLions. Packaging Guidelines for Use • MasterPolyheed 997 admixture is supplied in 55 gal (208 L) Dosage: MasterPolyheed 997 admixture has a recommended drums,275.gal(1040 L)totes and,by bulk delivery. dosage range of 3-15 fl oz fcwt (195-980 mU100 kg). of cementitious material'for.most concrete.Mixes: Related Documents As the dosageof MasterPolyheed 997 admixture increases to Safety Data Sheets: MasterPblyheed 0997.admixture 15 fi oz/cwt(980.mL/100 kg)of cemerititious materials,normal concrete setting characteristics are maintained and early and Additional Information ultimate compressive strengths increase. BASF does not recommend the use Of.dosages outside the For additional information on MasterPolyheed 997 admixture or recommended range without trial testing: Consult your local its• use in deve •loping concrete mixtures with special performance sales representative for assistance in determining the dosage Characteristics, contact your local sales representative: for optimum'performance. The Admixture Systems business-of BASF'S'Construction Chemicals division is the leading provider of solutions that Product Notes improve placement, pumping, finishing, appearance and Corrosivity — Noo-Chloride, Non-Corrosive: MasterPolyheed performance characteristics of specialty..concrete used in the.ready-mixed,precast,manufactured concrete products; 997 admixture will neither initiate nor promote corrosion of underground construction And.'paving markets. For over reinforcing or•prestressing steel embedded in concrete, or T00 years we have offered reliable products'and innovative of galvanized steel floor and roof systems. MasterPolyheed technologies, and through the Maater Builders Solutions 997 admixture does not contain intentionally added calcium brand, we are connected globally rvlthi experts from many chloride or other chloride-based ingredients. fields to provide sustainable solutions for the construction Compatibility: MasterPolyheed 997 admixture may be used industry in combination with any BASF admixtures. When used in conjunction with other admixtures, each admixture must be dispensed separately into the concrete mixture. BASF Corporation Admixture Systems wwwmaster-builders-solutions.basf.us page 2 of 3 MasterPoll/heed 997 Technical Data Sheet Limited Warranty Notice BASF warrants this product to be'free from manufacturing defects and to meet the technical properties on the current Technical Data Guide, if used.as directed within shelf life. Satisfactory results depend not only on quality products but also upon many factors beyond our control. BASF MAKES NO OTHER WARRANTY OR GUARANTEE, EXPRESS OR IMPlJED,INCLUDING WARRANTIES OF MERCHANTABILITY .0Ft FITNESS FORA PARI1CULAR PURPOSE WITH RESPECT TO ITS PRODUCTS. The sole and exclusive remedy of Purchaser for any claim concerning this product,including but not limited to,claims alleging breach.of warranty negligence, strict liability or otherwise,is shipment to purchaser of product equal to the amount of product that fails to meet this warranty or refund of the original purchase price of product that fails to meet this warranty, at the sole option of'BASF, Any Claims concerning this.product must-be received in Writing within one(1)year from the date shipment and any•Ctaims not presented within that period.are waived by Purchaser BASF WILL NOT BE RESPONSIBLE-FOR ANY SPECIAL INCIDENTAL CONSEQUENTIAL(INCLUDING LOST PROFITS) OR PUNITIVE DAMAGES OF ANY KIND. Purchaser mist determine the suitabilitY of the products for the intended use'and assumes II risks and liabilities in cenneOtion Therewith.This infOrrhation and all further technical advIcti are based on BASF's present knowledge and experience;HOwever; BASF assumes no liability for providing such information.and advice Including the extent to which such information and advice may relate to existing third party intellectual property rights, especially patent rights, nor shall any legal relationship .be created by or arise from the provision of such information end advice. BASF reserves the right to make any Changes according to technological progress or further deVelopMents. The Purchaser of the Product(s) must test the product(s) for suitability for the intended application and purpose before proceedin4h a full appricatfoh of the prOduct(s).Performance Of the product described herein should be verified by testing and carried out by qUaltiled experts. NSF.' .e. ed 907 bar-amo MwtorPob•hocd 907 Lawler tho Maztcr Buil Sizailim i•ard.cffsK:t ..1rinwiry 1.2014, 0 B&W Corpora/on 2010 Oi/IS 2 PRECtic-0060 United Stahts panada BASF Corporation 237120 Chagrin aculeard 1800 Clark Er....devacd Admixture Systerns aiweidnd.Chia 4422-6544 Brampton,0,-.1a6o LOY 4M7 www.master-builders-solutions.bastus Tot 000 629.0740 2 RUG 216 838-8021 7:); 287-5662 U Fax:SC6 702.0661 page 3 of 3 Engineer Addition - Y Washington State DepaAmant of January 10,2022 Qualified Product List Contractor Product Information Contractor: Contract No: Sub Contractor: Date: Bid Item: Manufacturer: BASF Corporation (formerly BASF Construction Chemicals, Inc.) - Cleveland. OH Product Name: MasterPolyheed 997 Standard Spec : 9-23.6(2), Concrete Admixture -Type A - Water-Reducing Admixtures Product Description : Liquid normal range water reducing admixture for concrete: Type A Product Restriction : Acceptance Code : 2250 Code Description : Acceptance is by field verification and the retaining of the Concrete Producer's Certificate of Compliance indicating the product and dosage of the admixture conform to the concrete mix design. Last Updated : Jul 31, 2019 To be completed by the field inspector: Quantity: Verified By: Date: wiiii CONSTRUCTION TESTING LABORATORIES, INC. 400 Valley Ave N.E., Suite 102,Puyallup,WA 98372 TN 0 253.943.4776 1 Fax#253.770.8232 wsbsito:wwe ctlwa.00m MISC . LABORATORY TEST REPORT CLIENT ' Miles Sand& Gravel REPORT DATE December 28, 2021 PROJECT MISC. TESTING REPORT 268 TITLE NU4BE PRAO 1ST N/A Ate PROJECT 4303 CONTRACTOR N/A NUMBER ',Km NIA CONTRACT N A PLRCrusf NIA JC CRLER NAORDER NO. LARGER NO. ORDERnD MATERIAL INFORMATION Q ) ASTM C117,C123. C142,Wood Waste DATE 12.09-2021 REQUESTED opTA En MATERIAL AASHTO Grading#57(YP Washed) CB-RINE::HY Client-Alex B. SOURCE Canyon Pit,B-329 SUBMITTED 5T I Client-Alex B. CIE SAMPLE LAB NUMBER 21-1730 ---LOCAT.ON Stockpile OF SUPPLY D.NUMBER MISCELLANEOUS TESTS SULFATE SOUNDNESS SODIUM CLAY LUMPS S 4,w000 FRIABLE 0.0 %REQ- 2 0 max WASTE (A) ,,REQ. ; fit)rn;zx COARSE FINE PARTIC LES FINE AGGREGATE %RiQ. 1 N200SCREEN 0.3 %REQ 1 0'TI3x SZE %LOSS SZE %LOSS ANGULARITY SAND EQUIVALENT A REQ. I ORGANIC %RED. 4"-3'/i (REF.METHOD' j IMPURITIES Light Weight Pieces, LOOSE UNIT Specific Gravity 2.0 0.0 X REQ. 2.0 max %REQ. 3 W-3' WEIGHT (coal&lignite) WT.PER DEGRADATION %REQ. I CU/FT 'N.REQ 3"-2'A' RODDED 2'. -1 lc , #14-#8 FRACTURE FRACTURE (SINGLE FACE) I (DOUBLE FACE) 1 'A"-34" #8•#16 SIZE RESULT SIZE RESULT %"-3/8' #16-#30 • %REQ. 's.REU 3/8"-#4 #30-#50 R,Rea j %REQ TOTAL TOTAL ATTERBERG LIMITS _ Requirement: PLASTIC %REO. LA ABRASION LIMIT(PL) LIQUID %REQ. _ Grading: Result: LIMIT(LL) . PLASTICITY x REQ. %REQUIRED INDEX(P1) COARSE AGGREGATE-SPECIFIC GRAVITY FINE AGGREGATE-SPECIFIC GRAVITY SSD Apparent SSD Apparent OVEN DRY %ABSORPTION OVEN DRY %ABSORPTION Flat&Elongated RESULT(S)/STATUS Ratio: Flat: By Weight ® Elongated: By Pieces ❑ Flat&Elongated: Total• r.- Requirement REVIEWED EVIAPPROvc2 C1 B ------ LA REMARKS EQUIPMENT SETS 2, 13, 14 TECHNUCIAN B. ROwden/d„ C. Pedersen REPORT SHALL NOT BE REPRODUCED EXCEPT IN FULL,WITHOUT THE WRITTEN APPROVAL OF CONST.TESTING 1G,INC.REPORT PERTAINS ONLY TO THE MATERIAL TESTED.(Revised 08-24-2020) , CONSTRUCTION TESTING LABORATORIES INC. c 400 Valley Ave N.E., Suite 102,Puyallup,WA 98372 TM#2533834778 1 Fax 1253.770-8232 wsbsite:www.cOvea.cam MISC . LABORATORY TEST REPORT -ute- Miles Sand&Gravel REPORT DATE ' December 28, 2021 PROJECTI MISC. TESTING REPORT 266 • PROJERE N/A PROJECT 4303 • %UMBER coNTRACTOR NIA ._.._.. WORK CONTRACT PLROKASE JCR CROER ORDER No. N/A ORDER NO. N/A ORDER pc N/A vaueER NIA MATERIAL INFORMATION REQUESTED-0TEST(S) ASTM C40.C117,C123,C142 Demo 12-09-2021 MATERIALvpE Concrete Sand(Building Sand) OBTAINED BY Client-Alex B. souRCE Canyon Pit,B-329 SUBMITTED BY Client-Alex B. OF SAMPLE j__ _ LAB NUMBER 21-1728 l.- LOCATION Stockpile 'D '»OR OF SUPPLY MISCELLANEOUS TESTS SULFATE SOUNDNESS SODIUM CLAY LUMPS& 5t WOOD FRIABLE 0.0 'x REQ. 3.0 m:ix WASTE %REQ. COARSE FINE PARTICLES FINE AGGREGATE y Rip, 01200SCREEN 1.5 %REa. 2.5 max SIZE ANGULARITY Loss SIZE LOSS SAND EQUIVALENT REQ ORGANIC P aEo R j ;x (REF.METHOD) IMPURITIES a l 3 Light Weight Pisces, I LOOSE UNIT Specific Gravity 2.0 0.0 %REQ. 1.0 max WEIGHT RE° 3%i—3" (coal&lignite) WT.PER 1I DEGRADATION %REQ. CUIFT RE{] 3" /P- -2 RODDED 2 W—1 'A" #4-#8 FRACTURE FRACTURE 1 'h'—'Y+" #8-#16 (SINGLE FACE) (DOUBLE FACE) SIZE RESULT SIZE RESULT '4"-318' #16-#30 —REQ. %REQ. 3/8"-#4 I #30-#50 %REQ. %REQ. TOTAL ' TOTAL ATTERBERG LIMITS Requirement: PLASTIC %REQ. LA ABRASION LIMIT(PLI • LIQUID %REQ. Grading: Result: LIMIT ILL) PLASTICITY %REQ. S.REQUIRED INDEX(PI) COARSE AGGREGATE—SPECIFIC GRAVITY FINE AGGREGATE—SPECIFIC GRAVITY SSD Apparent SSD Apparent OVEN DRY S.ABSORPTION OVEN DRY %ABSORPTION Flat&Elongated RESULT(S)I STATUS Ratio: Flat: By Weight ® Elongated: By Pieces ❑ Flat&Elongated: Total: Requirement: LAB REMARKS EQUIPMENT SETU 2, 13, 14, 16 TFC-IN'C'" B. Rowdenh C. Pedersen REPORT SHALL NOT BE REPRODUCED EXCEPT IN FULL,WITHOUT T.1E WRITTEN APPROVAL OF CGNST.TESTING_AB INC REPORT PERTAINS ONLY TO THE MATERIAL TESTED. (Rev sec 08 24 20201 Washington State 7,I Department of Transportation WSDOT MATERIALS LAB 47/3U2O�S Aggregate Source Approval Report Owner: Miles Sand and Gravel Aggregate Source: PS i s2u Lessee: Known as. Miles Canyon Road Pit Located in: E1/2SE1/4SE1/4,E3/8NE1/4SE1/4 Section 24 T2ON R3E County: Pierce Remarks: Mineral Agg. and Surfacing: Test Date: 11/07/2014 Expiration Date: 11/07/2019 Absorption. 1 033 Apparent Sp.G.:2751 Bulk Sp.G.(SSD):2.703 Bulk Sp.G,:2.676 Deg 79 LA:11 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 Portland Cement Concrete Aggregates: Test Date 06;20/2018 fxp+ration Date: /10J2023 ASR-14 Day:0.51 ASR-One Year 0.02 CCA Absorption-1.02 CCA Sp.G:2.69 Deg:72 FCA Absarptron 2 04 FCA Organics:1 FCA Sp.0:2.641 LA:11 Remarks: 1-Year ASR Results expire 08/04/2019 -ZK Currently approved for: Coarse Concrete Aggregates Fine Concrete Aggregates Acceptance tests need to be performed as necessary NOT approved for: Riprap, Quarry Spells, Rock for Rock Wall, Erosion and Scour Protection: Test Date: Expiration Date: Absorptror. A.e,,ir nr _.p ;_, BLIk Sp G (SSDI Bulk Sp.G.: Deg: LA. Remarks: NOT Approved for: Quarry Spells R+prap Rock for Erosion and Scour Protection Rock for Rock Walls Stone 9-27 31 Streambed Aggregates: Test Date: 06/20/2018 Expiration Date: 06/20/2023 Absorption: 1 02 Apparent Sp.G.:2,737 Bulk Sp,G.(SSD) 2.69 Bulk Sp.G. 2 662 Deg 72 LA:11 Remarks: Currently Approved tnr: Streambed Aggregate Gravel Borrow for Structural Earth Walls: Test Date: 06/20/2018 Expiration Date: 06/20/2023 Bulk Sp.G.lSSD):2.69 Deg-72 LA:11 Remarks: Contact RME to determine if Resistivity,pH, Chlorides, or Sulfates testing is required Currently Approved for: Gravel Borrow for Str Earth Walls 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) 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 National Ready Mixed Concrete Association qq°C Certificate of Conformance For Concrete Production Facilities N RMCA THIS IS TO CERTIFY THAT Pacific Plant 202, Pacific, WA Miles Sand & Gravel Company 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 OF WASy�� -r -�, CO cr Z Signature of Licensed Professional Engineer ect `14 January 21, 2021 April 18, 2023 9°A% AF sz�%.ti Inspection Date Certification Expiration Date SUBMITTAL REVIEW This company will maintain these facilities in corm and will correct promptly an cficiencies which develop. X No Exceptions Taken Make Corrections Noted /Z€474 Amend & Resubmit 1 C1 Rejected-See Rernarics Signature of Company Official IMPORTANT NOTICE This review Official does not relieve the Contractor from NOTICE:The Check lat imitates only that plant ladies are satisfactory responsibility to comply&conform manesatie °0nae1eibeJ"Idi rellutlementsmiitbevwMtedbyusualk"P" with the Plans, Specifications. and This conic*is issued by the Notional Reedy Pitied Concrete Association a Contract Documents ante Mite NR14CA Cart inron of Reedy Mixed Concrete Production Fealties,0C3.Ur I in NO aclon. Plant ID#:801670 ("'""y L' €11k1°111e' in" 7133 ® 1965, 1992,2001, G(NMSL�Tiv5 Eh GINEER5 By MB Date 1/10/22 Rational Ready Mixed Concrete Association 66 Cana Virginia 22314 National Ready Mixed Concrete Association VIC Certificate of Conformance For Concrete Production Facilities NRMCA THIS IS TO CERTIFY THAT Kent Plant 203, Kent, WA Miles Sand & Gravel Company 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 &atching and Recordings of Cementitious Materials, Aggregate, Water, and Chemical Admixtures ,Q�G CFtAq�F 1 ����wasy,H d'�� ,�' / �f w .....i, . 0 1 .� / ' Signature of Licensed Professional Engineer 45. 9° '�Q,s ��`�v January 19, 2021 March 19, 2023 s ‘" +t 'M- Inspection Date Certification Expiration Date This company will maintain these facilities in corm SUBMITTAL REVIEW and will correct promptly y deficiencies which develop. X No Exceptions Taken lei- Make Correct►ons Noted I 4� Amend 8 Resubmit Rejected-See Remarks Signature of Company Official OfficialIMPORTANT NOTICE This review NOTICE: e Check List b+dicatesa*hat punt Wilkes are satisfactory not relieve the Contractor frommance The of the concrete bet with specification requirements must be verbal by usual ham responsibility to comply&conform with the Plans. Specifications. and This catilc$le is issued by he National Ready Atoned Concrete Assoc111cm o Con tract Documents Muds of the NRMCA CeAllicabon of Ready Mad Concrete Production Facilities,0C3.Ur t In repel actor Plant ID 4:801815 Grimy Sic tAii.o Yse,Lao. 3890 © 1965, 1992,2001, corinamn ENGINEERS National Ready Mixed Concrete Aatadadon 66 Cane By MB _ NW:1/10/22 won'.22324 ASH GROVE Mill Test Report Plant Seattle Cement Type GU&14l Low Alkali Date 21-Oc1-21 Production Period September 1.2021-October 1,2021 Certification No. 2021-17 STANDARD REQUIREMENTS ASTM C 150 Tables 1 and 3; CSA Tables 1 and 4 CHEMICAL PHYSICAL Spec,Limit Spec lest Spec Limit Spec. lest item Type GU Limit Result Item Type GU Limit Result SI02(%) A A19.9 Air content of mortar(volume%) A 12 max 6 A1203(%) A6.0 max 4.8 Blaine fineness(m11kg) A 260 min 383 Fe2O3(%) " 6.0 max 3.4 %Passing 325 mesh 72 moo A 98.8 Cat(%) 84.7 Autoclave expansion.(%) 1,0 max 0.80 max 0.10 Mg0(%) 5.0 max 6.0 max 0.7 Compressive strength MPa(PSI) min: min: 503(%) 3,0 max 3 0 max 2.8 1 Day A A 14,9(2160) Ignition loss(%) 3.0 max` 3.5 max 2.9 3 Days 14.5 12.0 27.4(3970) Na2O(%) A A 0.22 7 Days 20.0 19.0 352(5100) K20(%) " 0,34 28 Days 26,5 A 43.5(6310)1 Insoluble residue(%) 1.5 max 1.5 max 0.40 Tn1e o1 setting(minutes) CO2(%) A ° 2.0 Vicat Initial not less than 45 45 100 Limestone(%) 5 max 5.0 max 4.6 Final not more than 375 375 177 CaCO3 in lmesiorte(%) " 70 min 96 Heat of hydration(callg) Inorganic processing addition(%) A 5.0 max 0.8 _ 7 Days A A 89 8" (Baghouse Dust) Potential phase composition(%Ic C3S A ° 57 C25 A 4 13 C3A " 8 max 7 C4AF A A t0 C4AF+2(C3A) A ° 24 C38.4 75(C3A) 90 OPTIONAL REQUIREMENTS ASTM C 150 Tables 2 and 4 CHEMICAL PHYSICAL Spec,Limit Spec I est Spec Cimit Spec test tern Type GU Limit Result Item Type GU Limit Result Equivalent alkalies(%) 0.60 max 0 44 r ilia,et(%) ° 50 min 88 °Not applicable. °Test result represent%most recent value and Is provided for Information only. cAdiusted per Al.6. °Fineness: 45pm sieve,maximum%retained,28. 'The reported 28 Days are for the previous production period rAn ignition toss of 3.5°6 maximum is allowed provided the cement at 650 t 25 C.show a loss in mass of no more than 3.0%. ADDITIONAL DATA Inorganic Processing Addition Data Type Baghouse Dust Amount(%) 0.8 Si02(%) 14.8 A1203(%) 6.5 Fe203(%) 1.5 Ca0(%) 40.9 503(%) 0.7 Base Cement Phase Composition C3S(%) 61 C2S(%) 14 C3A(%) 7 C4AF(%) 11 We certify that the above described cement,at the time of shipment,meets the chemical and physical requirements of the ASTM C1501C150M-18 specification and the CSA A3001-13 Type GU specification. Signature: Title: Chet Chemist Edward C.Rafacz 3801 E Marginal Way S,Seattle,WA 96134: Ph:(206)623-5596; Fax:(206)623-5355 Engineer Addition 0 Washington State Department of January 10,:2022 Qualified Product List Contractor Product Information Contractor: Contract No: Sub Contractor: Date: Sid Item: Manufacturer: Ash Grave Cement Company - Seattle,. WA Product Name: Portland Cement Type I, Type I/II low alkali, Type III ; (AASHTO M-85, ASTM C-150) Standard Spec : 9-01.2(1), Concrete - Portland Cement Product Description : Manufactured -Seattle, WA: Portland cement Type I,Type I/II low alkali;. Distributed from: Seattle, WA, Portland, OR and Spokane, WA-'Portland cement Type III distributed from: Seattle,WA and Spokane,WA, Product Restriction : Acceptance Code 2525 Code Description : Acceptance based upon the cement Manufacturer's Mill Test Report number being' shown on each concrete producer's certificate of compliance. Last Updated : SeP 24, 2012 To be completed by the field inspector: Quantity: Verified By: Date: � Washington State r// Department of Transportation Request for Approval of Material Contract Number FA Number SR Date CAG 20-065 N'A Duvall Ave NE 8/31/21 Section 1 Title of Project Duvall Ave NE County King Contractor Reed Trucking & Excavating, Inc. Subcootrattor t 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 Inforrnadon that was omitted. RAM# 042 PE Use Bid Item Material or (came and Location of Fabrcator, Speidficalion PE/QPL Hagtr 1QPt. Ha Use No Productlrype Manufacturer or Pit Number Reference Code Code B21 Precast Oldcastle Precast 7-16 3 621 SLDE Ductile Sigma 7-16 Iron Pipe 2 B21 Stargrlp 3000 Star Pipe Products 7-16 2 —1 Project Engineer/Reoresentative Date State Materials Engineer/Representative Date � - 1 10/21/2021 Acceptance Action Codes for use by Project Engineer and State Materials Laboratory 1. Acceptance Criteria: Acceptance based upon"Satisfactory"Test Report for samples of matenats to be incorporated into project. E... iAcceptance Criteria: Mfg.Cart of Compliance for'Acceptance'prior to use of material See Remarks Acceptance Criteria: Catalog Cuts for'Acceptance'prior to use of matenal.Catalog Cut Approved X,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: 1 Miscellaneous Acceptance Criteria. Remarks (PE): Mfg. Cert. of Compliance shall meet requirements of WSDOT 1-06.3. Remarks (HQ): DOT Form 350-071 Project Engineer Distribution Revised 03/2021 ®Contractor D Region Operations E,gineer El Fabrication Inspection El Region Matenats 0 State Materals Lab-MS 47366 n ,f% S'!AR PIPt: PRODUCTS Joint Restraint submit-_:I orris BID ITEMS B06, B07, B08, B11. Stargrip®series 3000 1 B12, B15, B16, B17, B18, B21 �, Mechanical Joint Wedge Action Restraint for Ductile Iron Pipe SUBMITTAL INFORMATION r. PROJECT NAME: DUVALL AVENUE NE ' 4.4 9 ENGINEER: I PARAMETRIX ` CONTRACTOR: !REED TRUCKING & EXCAVATING I .. .._ .- * SPEC. SECTION: i . . Uuchle Oran FVC VII) (II il II ID 1411Z 11\\,. ruv,.......nd APPROVED AW WA A. FEATURES&ADVANTAGES • The Wedge Assembly is designed with a Break-Off Torque Control Nut that will only break off in one direction,ensuring proper installation. • The Stargrip"offers a full 5"deflection through 12"size,3"on 14"-24",2"on 30"-36"and I"on 4T-48". 11111:4 • Minimum safety factor of 2:1 • Stargrip°sizes 3"-36"are listed with Underwriters Laboratories Inc.and sizes 3"-1 T are approved by Factory Mutual Research. • The Wedge Assembly is designed to fit specific pipe sizes and is field repairable_ • No special tools are required for installation of the Stargrip". • Storgrip"eliminates tie rods and thrust blocks. • Stargript J may also be used on minimum SCH 40 steel pipe'up to 12 1-transition gasket required on 12"and under;.For 14" and larger steel applications,contact Star Pipe. MATERIAL SPECIFICATIONS: • Gland:Ductile Iron per ASTM A536,Grade 65-45-12 011114114 • Wedges:Ductile Iron per ASTM A536,Grade 65-45-12 heat treated to a minimum of 370 BHN • Wedge Finish: Thermally cured fluoropolymer epoxy coating1414 GLAND FINISH OPTIONS (Please check one): HARDWARE OPTIONS(Please check one): Ej Standard:alkyd enamel coating Standard:1-boot-,are F igh strength low alloy steel I 1I manufactured in accordance with ANSI/AWWA "--�f EllOptional:Starbond°TGIC polyester powder coating C l 11/A21.11-00 applied by an electrostatic spray process Ej Optional:T-bolts and nuts allay SS 304 per ASTM F593 ElOptional:Other(specify) a Opel:T-bolts and nuts alloy S5 316 per ASTM F593 Optional:T-bolts and nuts Fluoropol r Star-Blue COUNTRY OF ORIGIN OPTION(Please check one): El coated high strength low alloy steel manufactured in accordance with ANSI/AWWA C111/A21.11-00 Import EIIIIIIIIII( Domestic-MS Compliant � l� J REV.21 0r �[ A if REGKIERED rRACOMARK Of STAR FIFE PROC4.1CTS STAR'PPr Pecot CTS nOu5TON CORPOR41I1rat OW r-R(r}9 NO?PA...761_-%10-9011 T(rvRhslniMd wwwstvdp•proJo_n.com „ Page 1 nD46 311t STIR' PIPE PRODUCTS Joint Restraint ;urr7litt( l Form Sta rg ri p®series 3000 1 Mechanical Joint Wedge Action Restraint for Ductile Iron Pipe TECHNICAL INFORMATION Al - /0 MN SOFA 0 75 ,47\ \ I / �' 4--.....4 ,/,., ,lint_ . . ,., . , . . oils; ./ -\ I `/ \fli. G- ( - Ai •.its 4, STARGRIP"3000 SPECIFICATIONS' MA F W/NUTS APPROX C. Please NOM. PRESSURE A 0 C D E F TWISTED G NO.OF NO.OF check si es: SIZE RATING OFF WEDGES T-BOLTS (WT. 3 350 4.84 2.40 4.06 6.19 3/4 9.85 8.78 1' 4 a a 350 5.92 2.40 4.90 7.50 7/8 11.06 9.62 9.12 2 pig E I 4 350 8.02 2.40 7.00 9.50 7/8 I3.36 11 72 3 E. 8 350 10.17 2.51 9.15 11.75 7/8 15.25 137 4 6 17 C 13 350 12.22 2.51 11.20 14.xJ 7.8 17.25 15.88 15.62 6 ;41 C 12 350 14.32 2.51 13.30 16.25 7/8 19.50 17T 17.88 8 8 _.4 El 14 350 16.40 2.91 15.44 18.7.5 7/8 2'.25 20.12 20.9C 10 1 3 .1 2'04 I v l 16 E 18 350 18.50 2.91 17.54 21.00 7/8 23.34 22.22 23.00 12 12 r_ 250 20.60 2.91 19.64 23.25 7) Il 1 SUBMITTAL REVIEW 5? C 20 250 22.70 2.67 21.74 25.50 7l 7 5 X No Exceptions Taken 24 250 26.90 3. 0 25.94 30.03 Make Corrections Noted - C 30 250 33,29 3.49 32.17 36,88 1-1 Amend & Resubmit ,� 1:1111114 ❑ Rejected See Remarks 36 250 39.59 3 a9 38.47 43.75 1-1 I:4 IMPORTANT NOTICE: This review ri 42 250 45.79 5.15 44.75 50.62 1-3 does not relieve contractor from his 400 CI48 250 52.09 5.;5 51.05 57.50 I.3 responsibility to comply&conforrn 488 with the Plans. Specification. and "Ail Jheen.luny in inches estccpr whets.u'dkared. Notes: Contract Documents. • Stamrips•must he adequately wrapped or protected if they are collard by con rkci. Ememoil • For applications exceeding the marimunr pressure ratings listed please conty< uatzjrip"l. • For applications H itA vertical()Pets please contact Star Pipe Prmfircls for a c 401 � y&Osborne, Inc. C9NSULTING ENGINEERS C • For applications on existing pipe.the pipe needs robe structural&sound and -products in ononier for the wedges to Amason properly Please contact Star Pipe Products I B . D pate: UH 8/21 • 51.ec 42*&48"require eTfra long l':"x 8 FY'T.-bolo y PP.21.01 A REGISTH+ED IRAOEMARP Of:PAR Pin PR✓X)uCt} StAR•PIPE PIPC76ucts Provide Mfg. Cert. of Compliance. NOU115.7�eOIIPOS 1p ITQLL Rut 1403 4P'P-XYN rMx 991-559-90SQ w+.w.slocTlpRpnac eom TuvRharaw;d Page 2 Qualified Product List hops,/www.wsdot.wa.gov!biz'mats/QPLIQPLPrint.cfm?Product no=20,.. Engineer's addition Washington State (product review supporting documentation) October 19.2021 Qualified Product List Contractor Product Information Contractor: Contract No: Sub Contractor: Date: Bid Item: Manufacturer: Star Pipe Products - Houston, TX Product Name: Stargrip Series 3000 Standard Spec : 9-30.2(6), Pipe - Water Distribution - Restrained Joints (to 16-inches) Product Description : Ductile iron pipe: Mechanical joint restraint; 3 to 16 inch Product Restriction : Acceptance Code : 3102 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. If the Contract contains a Buy America clause, the PEO is responsible for acquiring a Certificate of Material Origin from the Contractor. Note 'Restrictions' when present. Last Updated : Sep 13, 2010 To be completed by the field inspector: Quantity: Verified By: Date: of 1 10i 19i2021, 11:54 AM BID ITEMS; B21 CARS ON 0 Oldcastle Precast" f Enclosure Solutions 1324 MSBCF (800) 735-5566 Heavy Wall Rectangular Straight MEDIUM DUTY ..- 13 a' --•- ••••• • .•s7f?'wino COVER: • ••• •••••••••••• Style: Flush .••.•.• I." •• •• Material: Ductile Iron ••.•••.••••••••• Weight: 33.0 lbs. •••' i'!••' Options: Logos and Special Markings •� • •�•�•.•.•••�•• White Interior _ BODY/UNIT: ' Material: Polyethylene Blend A lil Weight: 12"Depth:16.0 lbs J �, PI 18"Depth:20.0 Ibs) Standard Color: Black with White Interior Mouseholes: 2 t 17i" a 20" 14" 23i' 2 t ,11 Depths: '111.11 i Ililililihil .55"WaII I 18" E''1 ( Thickness ii ii m Note: ( il' �.r �,3"r Actual Goad rating is determined by 1"i 191 the bow and cover combination ls.,1 13i' 14 234 Weights and dimensions may varys tty 3" Wide x 4" Tall 2 Mouseholes 1324 MSBCF oldcastleprecast.com/enclosuresolutions WA R•veron 112011 Contact your Oldcasde Precast Enclosure Solutions Distribution Center for specific information and additional options. cet i 1 Oidcasttm PIIIICalit Inc. CARS()N Oldcastle Precast" Enclosure Solutions 1324 MSBCF (800) 735-5566 Heavy Wall Rectangular Flared MEDIUM DUTY Options: Available Lightweight Plastic Covers: Flush Solid Cover Flush Cover with Plastic Reader Door :: =..•s3 Flush Cover with Cast Iron Reader Door "a R Available Heavy Duty Plastic Covers: Flush Solid Cover Flush Solid Cover Available Polymer Concrete Covers: `" '* Flush Solid Cover Flush Cover with Cast Iron Reader Door '� ' :• IP Available Ductile Iron Covers: Flush Solid Cover J Reader Door Detail ush Cover with Cast Iron Reader Door Add On Options fir Covers: SUBMITTAL REVIEW Touch Read Hole ERT Holder(Plastic and Polymer Concrete Only) X No Exceptions Taken Make Corrections Noted Amend &Resubmit Rejected-See Remarks Raw Material • Meter Boxes are high-density Polyethylene,one-piece molded construction IMPORTANT NOTICE: This review Specifications: • wall tfldnessminimum sso" does not relieve contractor from his • Vertical wad rating minimum 15.000 Au. responsibility to comply&conform • Sidewall loading of 200lb side load,applied with a 4"x 4•plate_ with the Plans, Specification, and • Multi-layer wall constriction Contract Documents. • Black exterior surface to provide IN protection • Gay foaming for strength and insulating value • Wnite interior surface for ease of meter reading (i„ay .Osborne, Inca • Manufactured by Oldcastle Precast Enclosure Solutions CONSULTING ENGIIrEERf Cast Iron Meter Ring and • Made of cast iron conforming toASIM MB standards and marked with country of origin By: DRS Date: 10121121 Lid Specifications: • Coated with a factory applied water based asphalt paint • Castings are ground smooth and cleaned by shot blasting,uniform quality,free from sand holes,shrinkage,cracks and other surface defects,with a dimensional tolerance of+/-1116'per foot based on the accepted foundry tolerances outlined In the ken Castings Handbook published by the American Foundry Society. OPES Load Rating Key: Llgnt Out: PeOestnaiu'Greenhel; Medium Duty:Incidental.Non-delberale Traffic Heavy(Duty Incidental,Hon-deliberate Traffic Traffic Continuous Headway Traffic Note: Actual load rating is determined by the tins and cover combination.Weights and dimensions may vary sightly All Information contained on this sheet is current at the time of printing. Because of Oldcastle Precast, Inc.'s policy of ongoing research and development, the Company reserves the right to discontinue or update product information without notice. WA oldcastleprecasf.com/enclosuresolufions Revision t12011 Contact your Oldcastle Precast Enclosure Solutions Distribution Center for specific information and additional options. omit ordcas Inc. BID ITEMS B06, B07, 808, Bit 812, 815, 816, B17, B18, 621 L SIGMA TM Quality — Service —Commitment— Delivered. ONE-LOK'm Series SLDE for Ductile Iron Pipe .aa ,,.,4K. ---.,-. .... MI In . .i . ' �'• illk , !br ice. 'ar UMW= { .4 i , . i,..,:,,, I • �� lnirr it ' �- t {�t ,I.r rit 7........_ awl* it gi Features &Advantages: 11111110. INO 1) The SIGMA ONE-LOK Series SLOE is a mechanical joint restraining gland that ii implements a series of individually activated wedges into the mechanical joint follower 11. . gland.When the wedge segment is engaged by the actuating bolt,the primary contact Tim edges of each wedge segment lock onto the pipe wall.This action causes the primary �fiii) contact edges to grip the pipe and effectively restrain all classifications of ductile iron ONE�OK's urtaue can actldt allows lie restraining wedges pipe• m,ncr< gripping the pipe waal more seavery as millet force 2)ONE-LOK SLDE's precision contoured wedges provide proper contact and support increased. of the ductile iron pipe wall,Each wedge is manufactured with an elongated contour that tri evenly matches the outside circumference of each nominal diameter of ductile iron pipe. This elongated contour also eliminates the concern of damage to both the pipe wall and —ALI�`' the interior cement mortar liningpoint caused b y loading, even on the thinner pressure classes of ductile iron pipe. 3) ONE-LOK SLDE's wedge actuating bolt provides the installer with a visual torque indicator. The breakaway top ensures proper engagement of the wedge segment at the time of installation. Unlike other actuating bolts, the ONE-LOK SLDE is manufactured ONELOK'a can action alto eccommodalee delecbon cl the joint wing rleleleuon and abs mows for subsidence,seismwith a proprietary quality control system that ensures the breakaway tops will activate at the correct torque. The breakaway top is sized to match the same dimensions of or other Somas after inswaeon,up So lie maximum allowed aenecson the bolts and nuts used to assemble the mechanical joint fitting and follower gland, eliminating the need for special installation tools. Once engaged, the actuating bolt leaves a residual hex-head shank, allowing post-installation disassembly of the restrained joint,if necessary. Deflection Chart 4) ONE-LOK SLDE's unique wedge segment and actuating bolt design allows the two Nominal Size Item# Deflection components to interface using a cam action principle, allowing the wedge segments 3-12- SLDE3-SLDE12 5 deg to rock and increase their grip on the pipe wall as thrust on the assembled joint 14-16" SLDE14-SLDE16 2 deg increases. This also allows improved resistance to subsidence, seismic forces, and 18-30 SLDE18-SLDE30 1 5 deg other movement within the maximum deflection limitations of the mechanical joint under 36-64" SLDE36-SLDE64 1 deg applicable AWWA standards. SIGMA Corporation 700 Goldman Drive 800 999 2550 p i www.sigmaco.com Cream Ridge, NJ 013514 609 758 1163 f crm-sales@sigmaco_com ONE-LOK'r` Series SLDE for Ductile Iron Pipe Sample Specification: Restraint for standard mechanical joint fittings shall be incorporated in the design of the follower gland and shall utilize multiple wedge segments that act against the pipe, increasing their resistance as the line pressure increases. The assembled joint shall maintain the maximum flexibility and deflection of all nominal pipe sizes after burial Restraining gland,wedge segments, and actuating bolts shall be manufactured of high strength ductile iron conforming to the requirements of ASTM A536.Grade 65-45-12. Wedge segments shall be heat treated to a hardness of 370 BHN minimum. Dimensions shall be compatible with standardized mechanical joints conforming to the requirements AWWA C111/ANSI A21.11 and AWWA C153/ANSI 21.53 through 24" (latest revision). Breakaway tops shall be incorporated in the design of the actuating bolts to visually ensure proper torque. The manufactunng of the actuating bolt must incorporate a quality control procedure that is deemed acceptable by the specifier and positively assures precise and consistent operating torque of the breakaway top. The mechanical joint restraining devices shall have a working pressure rating of 350psi (for sizes 3-16") and 250 psi (for sizes 18-64')minimum and provide no less than a safety factor of 2:1. Restraint shall be UL Listed and FM approved in applicable sizes.Restraining device shall be SIGMA ONE-LOK'"'or approved equal. Materials: • Gland body.brackets.wedge segments&actuating bolts: ASTM A536 65-45-12 ductile iron. • Wedge segments are heat treated to a minimum hardness of 370BHN • T-head bolts&nuts: High strength, low alloy steel meeting AWWA/ANSI C111/A21.11 with minimum 65.000psi tensile strength and 45,000psi yield strength. /1----- A ` p MAL ., , kourst. 1., it , w ,,,,,„ i__T:, : : g - ��' cti Seon I ,-A�a Ss4tinn 1:-.0 Dimensions in Inches, Weights in Pounds Nom DI Steei )merisions Bolts and Inserts r T-both Gasket Pipe Item Wgt Pipe Pip Pressure +; Size OD OD C F 0 T P. d J K2 No Sin Torque Rating No Sae Torque No Item a ' , 3 SLDE3 5.50 3.96 -- 4 64 4.16 1.58 0.55 9.40 1 750 6.19 7.69 2 7,8 75-9.:: 4 5.'8'.I. 15-60 1 1G-3 4 S10E4 8 50 4.80 4 50 5 92 5.00 1.58 0.55 10.24 0.875 7 50 9.12 2 71E 75.90 ,.0 4 16 x 35 75.90 1 MG.: --->6 SLOES 10,00 6 90 6.625 8 02 7.10 1 58 0.60 12 34 0 875 9 50 11 12 3 703 75-90 :3i,,ii 6 34 x 3 5 75-90 1 MG-6 SLOES 14.50 9.05 8.825 10.17 0.25 1.83 0.75 14-32 04175 11.75 13.37 4 718 75-90 350 6 14 x 4.0 75.90 1 MG-8 10 540610 23.12* II 10 10 75 12 11.30 1.58 0 415 18 54 0 375 14 Da 15.412 6 7,8 75.90 350 8 . 0 90 1 NIG 10 12 81.0E12 29.06 13.20 12.75 14.32 13540. 1.58 0.85 111.80 0.875 18.25 17.88: a 71e 75-90 390 8 14 44.2 75-90 1 MG-12 14 .,;ODE 14 395,5 I030 -- n1Y.1 1550 1 r,.. In 2'2n 0 1,,5 Di r, 2025 10 ('5 75-90 :RA _ I _ .,4 rtt;-ia -fir SLDE16 40.67 17.40 - 18.50 17.54 1.77 1,21 23.74 0.875 21.00 22 SUBMITTAL REVIEW •a 1 MG-16 18 SLOE 18 60.33 19.50 --- 20.60 19.64 1.77 1.25 25 84 0 875 23.25 24 75-90 1 MG-16 20 SL0E20 69.00 21.60 ... 22.70 21.74 1.87 1.25 27.94 0875 26.60 27 , X No Exceptions Taken 75•90 1 MG-20 24 S4.0E24 103 67 25 80 _-- 26.68 25 95 1 32 1 47 32•4 0 875 30 00 31 Make Corrections Noted 75-96 1 MG-24 30 SLDE30 158_87 32.03 - 33.28 32.17 2.13 1.85 39„30 1-125 313.88 39 Amend&Resubmit 100.120 1 MGS-30 36 SLDE36 23450 36.30 - 39 59 36 47 3 19 175 44-07 1 125 43 75 46 Rejected-See Remarks 100-120 1 MGS-36 42 SLDE42 344.00 44.50 - 45.79 44.67 3.56 2.25 53.25 138 50.62 53 IMPORTANT NOTICE: This review 120.150 1 MG9-42 48 6,11E48 456.00 50.60 - 52.04 59 37 3.8' 2.25 59 55 1.36 57.5 80 does not relieve contractor from his I 120-150 I 1 h1GS-48 34 34.0E54 1045.03 57,56 _ 58.05 57 73 6.00 4,50 70.43 1375 63.20 67 responsibility to comply&conform 120.150 1 Num-5'4 60 Si_DE80 1136.00 61.61 412 50 61 78 6.27' 4.50 74 52 1.375 67 72 72 with the Plans. Specification, and 120-150 1 MGS-60 84 54.0E44 125800 65.67 _ 669i6 65.84 5,00 4.50 74.66 1375 71.t16 74 Contract Documents. 120-150 1 6408-64 ONE-LOK SLOE was previously referred to as model SLD 'Proo li anacalJoint basket P"Dim shows OD after head is broken/removed. Size ray at Osborne, Inc. Sizes 3"•12"is approved for thinnest class of DI pipe. Size CONSULTING ENGINEERS Size Size By: DRS Date: 10119121 CO A> Size Pe Sizes 54".60"and 64"are pressure rated at 250 psi on DI Pipe LISTED APPIII ED Sizes 4"-12"are FM approved for 175 psi on DI pipe. 2 1 SIGMA Corporation '.vww.stgmaco.com Provide Mfg. Cert. of Compliance. I SIGMA-m Quality— Service—Commitment— Delivered. One Lok SLOE WNedae Action Restra 1, Clean the fitting socket&pipe end. Lubricate mechanical joint gasket St . pipe end with soapy water or approved lubricant meeting AWWA C111/A21.11. EASE-0% PM Jose (A transition gasket is required if using onAO ; steel OD pipe) 0 414.,*„u.n.f 2. Insert the One Lok SLDE Wedge Restraint on the pipe with the lip extension facing the pipe end followed by the gasket, tapered side toward end of the pipe. 3. Insert the gasket along with the pipe into the fitting socket and seat the gasket firmly and evenly into the gasket cavity, 4111) keeping the joint straight. 4. Push the One-Lok gland toward the fitting and center it around the pipe with the lip evenly against the gasket. 3 I SIGMA Corporation www.sigmaco.com December 2018 SIGMA Corporation �, ? 77` x . .-k ' ' r2 x x ti rx F> a T ; -*ryri 3 1 : ' r s a . .. i v x y .a : ,. K..,., ,4.;� ..,#.. 12 . . ,. . .. e.z ... ... `k; . .M .i , . .1 .K4,4^'..?a .. Installation Instructions for Wedge Action Restraint with PVC Pipe & Mechanical Joint Fitting (Continued) 5. Insert the T-bolts with the T-head on the 1 fitting side and nut on the restraint side. and hand tighten the nuts. Make the joint ' , deflection as required keeping the wedge restraint centered on the pipe before ...44► torquing the T-Bolts. * 6. Tighten the nuts in an alternate method (STAR PATTERN)to the recommended „ , . „ torque of 45-60 ft-lbs for 3". 75-90 ft-lbs for ri rtiri � '4"-24",100-120 ft-lbs for 30".36", mt ".b\,. 120- 150 ft-lbs for 42",48", 54". 60" &64" v _ j_ - Q ) sizes, use of a torque indicating wrench is recommended to confirm the applied var 1 �„e torque. i 7. Hand tighten each actuating bolt in a clockwise direction until contact is made between each wedge insert and the pipe OD. Continue tightening the actuating ,, " bolts in an alternate method (STAR . 6, PATTERN) until all the break-off tops have • • ' been removed. Never tighten actuating • •t bolt more than 180 degrees before moving to the next bolt. %t Recommended Torque for actuating bolt- • 75-90 ft-lbs for 3"-24". 115 - 125 ft-lbs for 30",36",42",48",400+/- 5 ft-lbs for 54"60"64" SIGMA SEAL GASKET(MGS)is recommended for One-Lok sizes 30',36",42-,48",54-.60",64" 4 SIGMA Corporation .w.ww.sigmaco corn Qualified Product List 1https:/fwww.wsdot.wa.govlbizlmatsJQPLiQPLPrintcfm?Product no--20,.. • iigiineei's'additiion (product-review supporting'documentation),; ' Washington State October 19,2021 Qualified Product List Contractor Product Information Contractor: Contract No: Sub Contractor: Date: Bid Item: Manufacturer: .WA; Product Name: ONE-LOK SLDE Restraint Standard Spec : 9-30.2(6), Pipe- Water Distribution - Restrained Joints (to 16-inches) Product Description : Restraint for ductile iron pipe; 3-inch to 16-inch Product Restriction : Acceptance Code :.3102 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. If the Contract contains a Buy America clause, the PEO Is responsible for acquiring a Certificate of Material Origin from the Contractor. Note 'Restrictions' when present. Last Updated : Jan 3, 2019 To be completed by the field inspector: Quantity: Verified By: Date: • 1 of 1 10119/2021, 11:18 AM