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ae Project Name Here Rew > Client Logs
INSPECTION AND TESTING PLAN (ITP) FOR CONSTRUCTION
Date | Jan-29.2012
ae . lame of company | = Mandatory HOLD Points
Document Ne (0200-€- 0004.17 Print Name Signature [Ns SY | Representative of net pry ent be
inawendance.
Prepared By: Subcontractor | W Witness Point
Representative ofindeated pany tbe
INSPECTION AND TEST PLAN (ITP) Fo! notified not in attendance at specified time,
EXCAVATION AND BACKFILLING | Approved By SSEC | inspection may proceed.
FOR UNDERGROUND UTILITIES 4 RIS = Review! Survellance,
Represetaive of indicated party to review!
Company App: PMT | surveillance work activity submited
| documents, results of teste
(Characteristics Quality Control, | Acceptance Criteria’ | Quality Verifying | lnspection Responsibiity
tobe Neriied Werfcaion Activ] Speciation | Document VD) [scant sae [Pan] pcr] BO
Inspection Activity
Approved Material |SES-Co2-so2 =
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1 | Backfil material approval [Approved Document
2. [Excavation/Trenching
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Dewatering pion [As perinpeion tere ses-co-sz ; ;
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INSPECTION AND TESTING PLAN (ITP) FOR CONSTRUCTION [> aie
Paleaareee taacrites | uit Coto! | acceptance! | QutyVeribing | MepectonResponainy |
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Se party test reportCompany Logo Glient Lego
(200-6017 0D
‘SOIL INSPECTION CHECKLIST FOR EXCAVATION AND [=
SURFACE PREPARATION IN CONSTRUCTION PHASE | ="!
Project No. ‘Area No.
Location Description | Drawing No
‘Sub cont _[_Main Cont
tem Description of Chack
acc | Rey [Acc | REV
01 | Excavation cleared of foreign and loose material
02 | Slopes shored or correcty stepped.
03 | Dewatering system is adequate
‘Sample collected and tested for proctor value and optimum]
‘moisture content and results recorded
Fill Material cleans and conforms to requirements (
Tequited over excavation fil)
Final elevation in accordance to drawings.(Bottom of
Foundation/Structure)
of
0s
06
7 | Field density test acceptable.
Moisture control acceptable,
Install concrete tilesiwarring Tape (if applicable)
NOTES : aitacned 3 Party Test Report or Sample Colecion
~[__ Subcontractor ain Contractor Par
Signature |‘Company Loge Cont Logo
0200-6-0002-0VD
BACKFILLICOMPACTION CHECKLIST Record No
Date
Project No Area No.
Material Type Drawing No.
‘Compaction Equipment. |Optimum Moisture| %
Field Test Equipment A Proctor Density.
| ocationDescipion
Results
sn
Yes [No | NA
1. |Keep cleared irom water, rts, trash, other foreign materia
Fl material test Report filed
3. |Coating protection filer board installed property
4 | Properly moistoned before placing
5 |Materia! comply with specification
6 _[Liftthickness and compaction pracedures in accordance with
specications
7 |Compacted Density
‘Subcontractor Main Contractor
PMT
Signature