Page 1/2 ‘Your Company Client Logo 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 = Document ses-corFoigs-as) pwnd Doameny Ho) W | HJ as 1 | Backfil material approval [Approved Document 2. [Excavation/Trenching T As per inspection tems | Measure and Viual|SES-Co2-S02 ial niddidtaioasa inthe Checklist of OVD [Check Ses-corroras-25)°%C-0001-0vD | M| W | NA | RS Dewatering pion [As perinpeion tere ses-co-sz ; ; 22 | applicable) in the Checklist of QV | Vistal Check SES-COL-FOI23-25)|°790C-0017-0VD | H | R/S | WA | RIS 1 As pensectiniems Jvc [seems |, : 23 [etek teshing anon [epee [vinaicneck — (SEECHSM Ieneocoorzovn| un | wal wa [aw 24 | Sample colton Aemoetdoamen [Smit lesen [mecome b a | | w Hype ofmmciat | as 25 lc ed egy every vamiciee (SESE sJomoconzove| an | rs | wa | es [CompactionPoe [2/2 Com me Project Name Here Rev. D Client Logo INSPECTION AND TESTING PLAN (ITP) FOR CONSTRUCTION [> aie Paleaareee taacrites | uit Coto! | acceptance! | QutyVeribing | MepectonResponainy | No tobe Verted een Asin) Speciexin | Docu (QVD) San] S850 Pur] PT 431 [beck beds firmed and | As pe inspection tems $-CO2-S02 31 compacted in the Checklist of QvD] Visual Check |SES-CO1-F01(23~25)|9%0°-C-0017-OVD | | A | Insta cnereesvaming | Asperinspestion tems SES-c02-soa = [Tape (if applicable) in the Checklist of QVD| Visual Check ISES-Co1-FO1(23-25)|20°-C-0017-QVD | H = ban i eeee es sES-co2-s02 33 |inpeston of Backing Layer] Aer inpeton is] Vinaicheck [Ses-coi-Foia3-25]omcam2gvo| u | w | wa | ws SESBSI-S0 Ises-consoe As pr nspeton ems o200-ca002-9vD 34 [rid Densiy TewLayer [AS ze nneton tere Ira gvigal Chel sES-C01F01(23-25} atwla lw SES BSI-SO1 Se party test reportCompany 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