FORM No.

PR 808-01-A4
CONSTRUCTION Subc No. ______________
Consecutive No.
QUALITY CONTROL Sheet 1 of 1

PLACEMENT & COMPACTION OF FILL MATERIAL RECORD

LOCATION
DRAWING NO
FILL CLASSIFICATION AREA OF FILL

SIGNATURE & DATE

A ) GENERAL SUBCONTRACTOR TSKJN

1. EXISTING SURFACE ACCEPTABLE

2. PLACEMENT OF MATERIAL ACCEPTABLE
3. WATER TREATMENT ACCEPTABLE
4. LAYER THICKNESS ACCEPTABLE
5. MINIMUM NUMBER OF PASSES IMPLEMENTED
6. COMPACTION EQUIPMENT UTILIZED CORRECT

THE ESTABLISH NUMBER OF PASSES AND THE THICKNESS OF LAYER FOR THE FILL MATERIAL
CLASSIFIED ABOVE IS AS FOLLOWS:
COMPACTION EQUIPMENT NUMBER OF PASSES MAXIMUM LAYER THICKNESS

ACCEPTANCE TEST (Indicate test report sheet reference number)

PROCTOR TEST ATTERBERG LIMITS

SIEVE ANALYSIS/PARTICLE SIZE DISTRIBUTION OTHER TEST
ORGANIC MATTER CONTENT

B. COMPACTION RECORD SIGNATURE & DATE

ELEVATION IN-SITU DENSITY TEST SUBCON TSKJN
LAYER DATE
FROM TO REPORT NO. Date

Comments:

ACCEPT Not ACCEPTED

Tested by :
Name (Subcontractor) Signed Date

Tested by :
Name (Subcontractor) Signed Date

Witnessed by:
Name (Contractor) Signed Date

Witnessed by:
Name (Company) Signed Date

JP 1000 NLG
Attachment PR808-01-A4 (01/03)