Formats P1 BKRP

Format No : ARTL/BKRP/F/01 Rev 0
Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000 to km 226+500 under
Raipur-Visakhapatnam Economics Corridor in the state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length 47.500
km)
Client : : National Highways Authority of India
Independent Engineer : : M/s SA Infrastructure Consultants PVT LTD
Concessionaire : : M/s Badakumari Karki Road Private Limited
EPC Contractor : : M/s Adani Road Transport Limited
REQUEST FOR INSPECTION (RFI)
RFI NO. Date :
Health, Safety & Environment Compliance : Yes No Work Can be started : Yes No
Note 1: Please Mark if found 'In compliance', If found 'Non compliant' and NA if not applicable
Work Permit Issued HIRA Fire Extinguiser Tool Box Conducted
Safe Access for Workplace First Aid Box Dust Control Plan Traffic Control Plan Implemented
Aspect Impact Analysis PPE Provided Fall Protection Edge Barricading Provided
Hazardous Chemical use Safety Supervision Waterbody Contamination Prevention Actions Implemented
Request for Inspection of works of :
Note 2 : Attachment of Checklist of each activity and Concrete Pour is Mandatory with this RFI for Acceptance
Clearing & Grubbing Aggregate Layer Toll Plaza Works Landscaping
Survey Kerb Rest Area Works DLC / PQC
Excavation Prime Coat /Tack Coat Layout Marking Hume Pipe Laying
NGL/OGL DBM PCC Drainage & Protection
Embankment BC/SDBC Formwork Dismantling Work
Subgrade RE Wall Pile Boring Structure Miscellaneous Works
GSB Retaining Wall Reinforcement Traffic Sign Board
WMM Road Marking Concreting Material Testing
CTB Soil Nailing Prestressing Others
CTSB Highway Miscellaneous Works Girder Erection
Location / Chainage : Side :

Work Particulars :
MCW SR ROB FLO VUP LVUP VOP MNB FOB BoC HPC Others
Description of Works
:
Layer /Grade of Concrete:
Time of Inspection:
Requested By (EPC/Sub.Contractor) Received By (Concessionaire / IE):
Name : Name :
Signature : Signature :
Date : Date :
Time : Time :
Remarks / Comments / Observations / Remedial Action given by EPC / Concessionaire
Pre-Construction:
Construction:
Post -Construction:
Remarks / Comments / Observations / Remedial Action given by NHAI / IE
Status
APPROVED Name Name Name
NOT APPROVED Sign Sign Sign
HOLD Date Date Date
EPC Sub-Contractor' Rep EPC/Concessionaire's Rep NHAI / IE's Representative
RFI Audited By Signature & Date Remarks if any
Format No.: ARTL/BKRP/F/02 R0
Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000 to
km 226+500 under Raipur-Visakhapatnam Economics Corridor in the state of Odisha on Hybrid
Annuity Mode (Package – OD-3) (Length 47.500 km)
Client : National Highways Authority of India

: M/s SA Infrastructure Consultants Pvt. Ltd. In Association
INDEPENDENT ENGINEER
with ROTRANS Infra Projects Pvt.Ltd.
CONCESSIONAIRE : M/s Badakumari Karki Road Private Limited
EPC CONTRACTOR : M/s Adani Road Transport Limited
DAILY PROGRAM (Q.C.Lab)
DATE:
S.NO DESCRIPTION REMARKS
Contractor EPC Contractor/Concessionaire NHAI/Independent Engineer

Representative Representative Representative
Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km
179+000 to km 226+500 under Raipur-Visakhapatnam Economics Corridor in the
state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length 47.500 km)
CLIENT : National Highway Authority Of India

INDEPENDENT ENGINEER : M/s SA Infrastructure Consultants Pvt. Ltd.
In Association with ROTRANS Infra Projects Pvt.Ltd.
SAMPLE CARD
Date of Sample :
Chainage :
Sample Location :
Type of Sample :
Sample Quantity :
Sampled By :
Tests Required :
Contractor EPC Contractor/Concessionaire NHAI/IE


179+000 to km 226+500 under Raipur-Visakhapatnam Economics Corridor in the state
of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length 47.500 km)

:M/s SA Infrastructure Consultants Pvt. Ltd. In
Association with ROTRANS Infra Projects Pvt.Ltd.
CALIBRATION OF SAND POURING CYLINDER
[As per IS 2720 (Part - 28)]
Laboratory No. : Date of testing :

Pouring Set No. : Tested by :
Proposed use : Source of sand :
Trials
Weight of Sand in Cone Average
1 2 3
1. Weight of sand in pouring cylinder before pouring, Wa
(g)
2. Weight of sand in pouring cylinder after filling in the
cone,Wb (g)
3. Weight of sand in the cone W2 (g) = ( Wa - Wb )
Bulk Density of Sand
1. Weight of sand in pouring cylinder before pouring W1 (g)
2. Weight of sand in pouring cylinder after filling in the
calibrating container and cone, W3 (g)
4. Weight of sand in the calibrating container, Wa=W1-W3-
W2 (g)
5. Volume of calibrating container ,V (cc)
6. Bulk Density of Sand Y = Wa/V (g/cc)
Note: Sand to be used shall be clean uniformly graded natural sand passing 1.00 mm sieve and
retained on 600 micron seive
RESULT
1. Average Bulk Density of Sand = g/cc
2. Weight of sand in Cone of the pouring cylinder = g
Remarks:
Contractor's EPC Contractor/ Concessionaire's NHAI/Independent Engineer's

Client : National Highway Authority Of India
: M/s SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS Infra Projects
Independent Engineer
Pvt.Ltd.
Concessionaire: : M/s Badakumari Karki Road Private Limited
EPC contractor : M/s Adani Road Transport Limited
Calibration of Rapid Moisture Meter No.
Calibration Date :- Due Date of Calibration :-
Wt of Dry Wt. of
RMM Wt. of Wet Soil+ Wt. Of Wt. of Moisture Water RMM Moisture
Soil+ Oven
Reading Container Container Water Content Added Reading Content
Container Dry Soil
RMM Reading Vs Moisture Content

4.00
3.80
3.60
3.40
3.20
3.00
2.80
2.60
Moisture Content
2.40
2.20
2.00
1.80
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.4 2.6 2.8 3.0 3.2 3.4 3.6 3.8 4.0
RMM Reading
Contractor's EPC Contractor/Concessionaire's NHAI/Independent Engineer

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from

km 179+000 to km 226+500 under Raipur-Visakhapatnam Economics Corridor
in the state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length
47.500 km)
CLIENT : National Highways Authority of India

: M/s SA Infrastructure Consultants Pvt. Ltd. In
CALIBRATION REPORT - CONCRETE BATCHING PLANT
Make Plant Location
S.No Date of Calibration
Capacity Calibrated by
Calibration Equipment Due Date of Calibration:
% of
Actual System Reading Average
Variation in
Weight System Remarks
System
(Kgs) Loading Unloading Reading
Reading
Acceptable Variation as per MORTH, Cl. 1707

Ingredients Aggregate's Cement Water Admixture
Allowable
variation in ±3 ±3 ±3 ±3
each batch
Contractor's EPC Contractor/Concessionaire's NHAI/Independent Engineer's


in the state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length 47.500
km)

: M/s SA Infrastructure Consultants Pvt. Ltd. In Association with
ROTRANS Infra Projects Pvt.Ltd.
CALIBRATION REPORT - HOT MIX PLANT
Make Plant Location

S.No Date of Calibration
Capacity Calibrated by
Calibration Equipment Due Date of Calibration:
System Reading % of
Actual Average
Variation in
Weight System Remarks
Loading Unloading System
(Kgs) Reading
Reading
Average
Recommended Tolerance as per IS 3066 Clause 14.3.1 Bitumen ± 2% Max.

Recommended Tolerance as per IS 3066 Clause 14.3.1 Aggregate ± 0.5% Max.
Recommended Tolerance as per IS 3066 Clause 14.3.1 Filler ± 0.5% Max.
Contractor's EPC Contractor/Concessionaire NHAI/Independent Engineer's

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000 to km 226+500
under Raipur-Visakhapatnam Economics Corridor in the state of Odisha on Hybrid Annuity Mode (Package –
OD-3) (Length 47.500 km)
Pvt.Ltd.
COLD BIN CALIBRATION OF WMM/HM PLANT
Plant ID/ Make: Date of Calibration:
Plant Location: Due date:
Length of Gethering Belt : m
Time of 5 Revoulutions of belt : sec
Time of 1 Revoulutions of belt : sec
Speed of the Belt : m/sec
: m/hr
Bin - 1 (40mm)
Weight per
Gate Out Put
Meter
Opening/
Moter
Speed kg TPH
Gate/ Motor opening
Output in TPH
Remark:



Concessionaire
Independent Engineer : M/s Badakumari Karki Road Private Limited
EPC Contractor : M/s Adani Road Transport Limited
WMM PLANT CALIBRATION
Plant Make Date of Calibration
Capacity Due Date of Calibration
Source : Location :
Actual Capacity of Plant TPH
Take Efficiency of Plant %
Runing Capacity of Plant TPH
Length of the Gathering Belt Metre
Avg. Time taken for10 Revolutions of the Belt Sec
Ave time taken for 1 revolution of the belt Sec
Speed of the Belt per Sec m/sec
Speed of the Belt per Hour m/hr
Estimated qty for 1m length of belt sample Kg/mt
WMM Plant Bin No. 1 2 3 4 Water Cell
Size of Aggregates (mm) Dust 10mm 20mm 40mm Water
Mix Proportion (%)
Required Qty (200 TPH)
Required Load Setting (%)
Remarks:-


km 179+000 to km 226+500 under Raipur-Visakhapatnam Economics Corridor in
the state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length 47.500
km)

: M/s SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS Infra
Projects Pvt.Ltd.
Concessionaire : M/s Badakumari Karki Road Private Limited
CRUSHER DUST
Source of Material Date of Calibration
Location Due Date of Calibration

Average
Weight (Kg/mt) OutPut Weight
Production
Load Setting (%) for 1m length
(TPH)
Trail -1 Trail -2 Trail -3 of sample
(Kg)
CRUSHER DUST
1
0.9
0.8
0.7
Production (TPH)
0.6
0.5
0.4
0.3
0.2
0.1
0
0 5 10 15 20 25 30 35 40
Load Setting (%)
Remarks :



Projects Pvt.Ltd.
10MM AGGREGATE
Average OutPut
Weight (Kg/mt) Weight for 1m Production
Load Setting (%)
length of sample (TPH)
Trail -1 Trail -2 Trail -3
(Kg)
10MM AGGREGATE
60
50
40
Production (TPH)
30
20
10
0
0 0.2 0.4 0.6 0.8 1 1.2
Load Setting (%)
Remarks :
EPC
Contractor's Contractor/Concessionaire's NHAI/Independent Engineer's

179+000 to km 226+500 under Raipur-Visakhapatnam Economics Corridor in the state of
Odisha on Hybrid Annuity Mode (Package – OD-3) (Length 47.500 km)
Pvt.Ltd.
20MM AGGREGATE
Weight (Kg/mt) Average OutPut

Weight for 1m Production
Load Setting (%)
length of sample (TPH)
Trail -1 Trail -2 Trail -3 (Kg)
20MM AGGREGATE
70
60
50
Production (TPH)
40
30
20
10
0
0 2 4 6 8 10 12 14 16 18
Load Setting (%)

Remarks :

Format No: ARTL/BKRP/F/08 R0
Development of Six Lane Badakumari – Karki Section of NH-130-CD Road
from km 179+000 to km 226+500 under Raipur-Visakhapatnam
Economics Corridor in the state of Odisha on Hybrid Annuity Mode
(Package – OD-3) (Length 47.500 km)
: M/s SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS
Infra Projects Pvt.Ltd.
40MM AGGREGATE

Average OutPut
Load Setting (%) Weight (Kg/mt)
Weight for 1m Production
length of (TPH)
Trail -1 Trail -2 Trail -3
sample
40MM AGGREGATE 15.2

120
100
80
Production (TPH)
60
40
20
0
0 5 10 15 20 25 30 35 40
Load Setting (%)
Remarks :



Projects Pvt.Ltd.
WATER CELL
Average Moisture Content

Load Setting (%) Moisture Content % in Mix
in mix %
% 3 TRIAL31 3 2
TRIAL TRIAL
3 3 3
WATER CELL
8.00
7.00
6.00
MOISTURE CONTENT %
5.00
4.00
3.00
2.00
1.00
0.00
1 1.5 2 2.5 3 3.5 4 4.5 5
Load Setting (%)
Remarks :
WATER :
5.8 % i.e, 11.60 T/hr for 200 T/hr production, Required Rate of flow = 3.22 litres/sec
Load Setting adjusted for required flow is 3.0
Water collecting Time-60sec, Required Water for 60sec = 193.2 litres,
Amount of water collected-192.5 lit

in the state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length
47.500 km)

INDEPENDENT ENGINEER :
Projects Pvt.Ltd.
SPECIFIC GRAVITY & WATER ABSORPTION OF COARSE AGGREGATE (Greater than 10mm)
[As per IS 2386, (Part - III)/ ASTM C127]
Laboratory Date Sampled

Type of Material Sampled By
Source Date Tested
Location Tested By
Proposed Use Size of Aggregate
1 2 3
Weight of saturated aggregates and Basket in water
(g)
(W1)
Weight of Basket in Water (W2) (g)
Weight of saturated surface dry aggregates in air
(g)
(W3)
Weight of oven dried aggregate in air (W4) (g)
Specific Gravity = W4/[W3 - (W1 - W2)]
Apparent Specific Gravity = W4/[W4 - (W1 - W2)]
Water Absorption = 100 x (W3 - W4)/W4 %
Average Specific Gravity
Average Water Absorption %
Note 1 : A sample of not less than 2000g of the aggregte shall be tested.
2 : The sample shall be completely immersed in water during the operation and for a subsequent period of
between 24 ± 1/2h and maintain the water temperature between 22-32 °C.
Remarks:
Contractor's EPC/ContractorConcessionaire's NHAI/Independent Engineer's

from km 179+000 to km 226+500 under Raipur-Visakhapatnam Economics
Corridor in the state of Odisha on Hybrid Annuity Mode (Package – OD-3)
(Length 47.500 km)

INDEPENDENT ENGINEER :
CONCESSIONAIRE : : M/sBadakumari Karki Road Private Limited
EPC CONTRACTOR : : M/s Adani Road Transport Limited
SPECIFIC GRAVITY & WATER ABSORPTION OF FINE AGGREGATE (Less than 10 mm)
[As per IS 2386, (Part - III)/ ASTM 128]
Laboratory No. Date Sampled

Source Date Tested
Location Tested By
Proposed Use
1 2 3
o
Temperature of Water C
Pycnometer Number
Wt of SSD sample, W1 (g)
Wt of Pycnometer + Water + Sample, W2 (g)
Wt of Pycnometer + Water, W3 (g)
Wt of oven dry sample, W4 (g)
Specific Gravity = W4/[W1 - (W2 - W3)]
Apparent Specific Gravity = W4/[W4 - (W2 - W3)]
Water Absorption (Dry basis) = 100 x (W1 - W4)/W4 %
Average Specific Gravity
Average Water Absorption %
Note: The sample shall be completely immersed in water during the operation and for a subsequent period of
between 24 ± 1/2h and maintain the water temperature between 22-32 °C.
Remarks:


COMBINED FLAKINESS AND ELONGATION INDEX
[As per IS 2386, (Part - I)]
Type of Material Date of Sampling

Source Sampled By
Location Date of Testing
Proposed Use Tested By
IS Sieve Size Total Weight of Weight of Weight of Aggregate

Weight of Aggregate
Aggregate Aggregate retained on length
retained on thickness
retained on passing from gauge after retained
Passing Retained gauge
Sieves thickness gauge on thickness gauge
(g)
(g) (g) (g)
mm mm W1 W2 W3 W4
63 50
50 40
40 31.5
31.5 25
25 20
20 16
16 12.5
12.5 10
10 6.3
Total Weight
Flakiness Index = W2 / W1 X 100 .= %

Elongation Index = W4 / W3 X 100 .= %
Combined Flakiness & Elongation index .= %
Specifications:
Type of work BC DBM BM WMM Concrete PQC
MoRT&H Clause 507.2.2 505.2.5.1 504.2.2 406.2.1.1 1007 602.2.6.2
Maximum Value (%) 35 35 35 35 35 (FI Only) 35
Remarks:

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000 to km
226+500 under Raipur-Visakhapatnam Economics Corridor in the state of Odisha on Hybrid Annuity
Mode (Package – OD-3) (Length 47.500 km)

:M/s SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS Infra Projects
Pvt.Ltd.
AGGREGATE IMPACT VALUE TEST
[As per IS 2386 (Part - IV)/ IS:5640]

Source Date Tested
Location Tested By
Proposed Use
Description Test 1 Test 2 Test 3
Weight of surface dry sample passing 12.5mm and retained on 10mm IS sieves, W 1.
Weight of fraction passing 2.36mm IS sieve after the test, W2.
Weight of fraction retained on 2.36mm IS sieve after the test, W3.
W4 = W1 - (W2 + W3)
Aggregate Impact Value (A.I.V) = (W2/W1) x 100
Average Value of A.I.V (%)
Note : If W4 > 1 g, discard and retest
Specifications:
Type of work BC DBM BM WMM GSB(wet AIV) Concrete DLC/PQC
MoRT&H Clause 507.2.2 505.2.5.1 504.2.2 406.2.1.1 401.2.2 IS 383 IS 383
Maximum Value (%) 24 27 30 30 40 45 30
Remarks :

from km 179+000 to km 226+500 under Raipur-Visakhapatnam
Economics Corridor in the state of Odisha on Hybrid Annuity Mode
(Package – OD-3) (Length 47.500 km)
BULK DENSITY
(As Per IS 2386 Part III)
Laboratory No.: Date Sampled:
Type of Material: Sampled By:
Source: Date Tested:
Location: Tested By:
Proposed Use
Material :
Description Test 1 Test 2 Average
Empty Weight of Measuring Cylinder (W1) (g)
Weight of Material + Measuring Cylinder (W2) (g)
Weight of Material, W= (W2-W1) (g)
Volume of Measuring cylinder (V) (cc)
Bulk Density (W/V) g/cc
Remarks :

AGGREGATE STRIPPING VALUE TEST
( IS : 6241 - 1971) / AASHTO - T - 182

Type of Mix Sampled By
Source Date Tested
Grade of Bitumen Tested By
Bitumen Content Temp. of Water
Size of Aggregate Wt. Of Aggregate
Visual Quality of Mix Wt. Of Bitumen
Description Sample 1 Sample 2

Grade of Bitumen
Weight of Dry Aggregate (g)
Temperature of Aggregate ( oC )
Temperature of Bitumen ( oC )
Weight of Bitumen (g)
Visual Estimation after 18 hours of immersion
RESULTS :
Specification : Retained Coating should be >95 %
Remarks:
EPC
Contractor's NHAI/Independent Engineer's
Contractor/Concessionaire
SILT & CLAY CONTENT OF FINE AGGREGATE
Test Method (IS:2386 Part II)
Location/Source Sampled by
Type of Materials Date of Test
Proposed Use Tested by
Wt. of Sample (g)
Description of Sample :
Weight of sample
Total Weight of Silt & Clay content
retained on 75µ IS Average
S.No. Sample (W1) {[(W1-(W2)]/W1}X100
Sieve (W2) (%)
(g) (%)
(g)
Remarks:
Contractor's EPC Contractor/ Concessionaire's NHAI/Independent Engineer's

CONCESSIONAIRE
EPC CONTRACTOR
CONSTRUCTION CONTRACTOR
Format No.: ARTL/KKRPL/F/15 R0
LOS ANGELES ABRASION TEST
[As per IS 2386, (Part - IV)]

Source Date Tested
Location Tested By
Proposed Use Weight of test sample of grade (g):
IS sieve Designation (mm)
No. of spheres
Passing on Retained on A B C D
40 25 1250
A = 12
25 20 1250
20 12.5 1250 2500
B = 11
12.5 10 1250 2500
10 6.3 2500
C=8
6.3 4.75 2500
4.75 2.36 5000 D= 6
Total weight (g) 5000 5000 5000 5000
No. of revolution 500 500 500 500
Description Test 1 Test 2
Intial Weight, W1 (g)
Weight retained after test on 1.70 mm IS

Sieve, W2 (g)
Los Angeles Abrasion Value =
{(W1 - W2) / W1} x 100 (%)
Average of Los Angeles Abrasion Value
(%)
Specifications:
Type of work BC DBM BM WMM Concrete DLC/PQC
MoRT&H Clause 507.2.2 505.2.5.1 504.2.2 406.2.1.1 IS 383 602.2.6.1/2
Maximum Value (%) 30 35 40 40 50 35
Remarks :
Contractor's Concessionaire's Independent Engineer's

National Highways Authority of India
(Ministry of Road Transport & Highways)
Government of India
CONCESSIONAIRE
EPC CONTRACTOR
SAND EQUIVALENT VALUE TEST

[As per IS 2720, (Part -37)]
Laboratory No.: Date Sampled:
Type of Material: Sampled By:
Source: Date Tested:
Location: Tested By:
Proposed Use:
Description Test 1 Test 2 Test 3
A. Sand Reading
B. Clay Reading
C. Sand Equivalent Value = (A/B)*100 (%)
D. Average Sand Equivalent Value (%)
Note: As per MoRT&H CL. 505.2.3 & 602.2.6.3, Sand equivalent value is 50 minimum
Remarks :

#REF! Page
Government of India
CONCESSIONAIRE
EPC CONTRACTOR
Format No. : SKRPL/QC/AGG/07 R0
AGGREGATE CRUSHING VALUE TEST
[As per IS 2386, (Part - IV) ]

Source Date Tested
Location Tested By
Proposed Use
N0. Description Test 1 Test 2 Test 3

1 WEIGHT OF EMPTY CYLINDER (W1)
2 WEIGHT OF CYLINDER FILLED WITH AGGREGATE (W2)
3 WEIGHT OF AGGREGATE (W3)=(W2-W1)
4 WEIGHT OF AGGREGATE PASSING THROUGH 2.36MM SIEVE (W4)
5 CRUSHING VALUE OF AGGREGATE= (W4/W3)X100
AVERAGE CRUSHING VALUE (%)
REMARKS :

Government of India
CONCESSIONAIRE
EPC CONTRACTOR
Format No. SKRPL/QC/AGG/11 R0
SOUNDNESS OF AGGREGATE
As per IS 2386 Part-V
Laboratory : Date Sampled :

Type of Material : Sampled By :
Source : Date Tested :
Location : Tested By :
Proposed Use :
Size of Aggregate Test Sieve Sample Wt.(gms) Permissible Limits
63 mm 40mm 31.5mm
Loss with Na2So4 Max.12%
40mm 20mm 16mm
20mm 10mm 8mm

Loss with MgSo4 Max.18%
10mm 4.75mm 4mm
Type of Re-Agent Used :- Na2So4 / MgSo4 No. of Cycles : 05
IS Sieve Size (mm)

weight of Persentage Passing
weight of Test Test Finer Sieve After Weight Average
Grading of Original
Fraction Before Fraction Test ( Corrent Percent
Sample Percentage
Passing Retained on Test (gms) After ( Actual Percent Loss )
Test (gms) Loss )
63 40
40 20
20 10
10 4.75
Total
Remarks:

0 Page
Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000
to km 226+500 under Raipur-Visakhapatnam Economics Corridor in the state of Odisha on
Hybrid Annuity Mode (Package – OD-3) (Length 47.500 km)
INDEPENDENT : M/s SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS Infra
ENGINEER Projects Pvt.Ltd.
CEMENT TEST REPORT (PHYSICAL PROPERTIES)
(AS PER IS: 4031 )
Source : Date of Sampling :
Brand of Cement : Date of Testing :
Batch No. : Sampled By :
Grade of Cement : Tested BY :
FINENESS OF CEMENT NORMAL CONSISTENCY OF CEMENT
Weight Trail No. 1 2 3 4
% wt.
Weight of of
Test No. Retain Average Wt. of Sample
the sample Sample
ed
retained Wt. of water
Consistency
(%)
Penetration
Standard
Consistency
Maximum Limit <10 % Standard Consistency at 5-7 mm Penetration
INITIAL AND FINAL SETTING TIME OF CEMENT COMPRESSIVE STRENGTH OF CEMENT

Comp. As per
Load in Average
Determination No. 1 Date of Test Strength Specification
(KN) 2) (N/mm2) 2
(N/mm (N/mm )
Normal Consistency
Time when water is added
3 days
to cement
Time at initial setting
Total time taken for initial
setting(minutes)
Time at final setting 7 days
Total time taken for final

setting(minutes)
INITIAL SETTING TIME (MINIMUM 30 MINUTE) 28 days
FINAL SETTING TIME (MAXIMUM 600 MINUTE)

Raipur-Visakhapatnam Economics Corridor in the state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length
47.500 km)
Pvt.Ltd.
SOUNDNESS OF CEMENT
Test Method: (IS 4031 PART - 3)
Laboratory : Date Sampled & Sampled by :

Cement Brand Name & Week : Date Tested :
Cement Grade: Tested by :
o
Room Temperature: C Room Humidity : (%)
Measured distance in
between the two
separating indicators Soundness in terms of
Sample Taken Normal Water required Specified
Before Le-Chatelier's
S.No. (W) Consistency (P) (0.78 X P X W) After putting 3 limits as per Remarks
putting in (A) -(B)
(g) (%) (g) hours in boiling IS: 8112 - 2013
boiling (mm)
water (B)
water (A)
(mm)
(mm)
Max 10 mm
Remarks:

Raipur-Visakhapatnam Economics Corridor in the state of Odisha on Hybrid Annuity Mode (Package – OD-3)
(Length 47.500 km)
INDEPENDENT ENGINEER : M/s SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS Infra Projects Pvt.Ltd.

SPECIFIC GRAVITY OF FILLER
CEMENT/LIME
TEST METHOD (IS 4031-Part 11/ASTM D 854 )
Sample Location Date of Sampling
Source of Material Dated of Testing
Sampled By Tested By
Description 1 2 3
Weight of 50ml Bottle A gm
Weight of 50ml Bottle with Kerosene B gm
Weight of 50ml Bottle + Cement C gm
Weight of 50ml Bottle + Cement + Kerosene D gm
Specific Gravity of Cement (Gfi) in Kerosene
Specific Gravity of Cement (Gfi) in term of Water
Average Specific Gravity of Cement (Gf)
Remarks:

#REF! Page
CONCESSIONAIRE
EPC CONTRACTOR
SIEVE ANALYSIS OF SINGLE SIZED COARSE AGGREGATE FOR CONCRETE
As per IS 2386 Part - 1

Weight of Sample (g)
Description of Sample :
Cumulati Specification Limits as per IS 383
Cumulati
Weight ve for individual aggregates
IS Sieve Size ve Passing
Retained Weight (% Passing)
(mm) Retained (%)
(g) Retained
(%) 40 mm 20 mm 10 mm
(g)
63 100 100 -
40 85-100 100 -
20 0-20 85-100 -
12.5 - - 100
10 0-5 0-20 85-100
4.75 - 0-5 0-20
2.36 - - 0-5
Pan
Remarks:

47.500 km)
Independent Engineer : M/s SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS Infra Projects Pvt.Ltd.
EPC contractor : M/s Adani Road Transport Limited
SIEVE ANALYSIS COARSE AGGREGATE
Type of Materials Date of Tested
20 mm Wt. of Sample Description:
Wt.of material Cum. Weight

Sieve size in(mm) % weight retained % Passing Specification Limit
retained retained
40 100
20 85-100
10 0-20
4.75 0-5
10 mm Weight of Sample : Description:
12.5 100
10 85-100
4.75 0-20
2.36 0-5
Combined Gradation (20mm 10mm ) Weight of Sample(gms):
40 100
20 95-100
10 25-55
4.75 0-10


SIEVE ANALYSIS OF FINE AGGREGATE FOR CONCRETE
As per IS 2386 Part I

Wt. of Sample
Cumulative Specified limits as per IS:383 &

Weight Cumulative
Weight Passing MORTH Table 1000-2, (%)
IS Sieve Size Retained Retained
Retained (%)
(g) (%)
(g) Zone I Zone II Zone III
10 mm 100 100 100
4.75 mm 90-100 90-100 90-100
2.36 mm 60-95 75-100 85-100
1.18 mm 30-70 55-90 75-100
600 micron 15-34 35-59 60-79
300 micron 5-20 8-30 12-40
150 micron 0-10 0-10 0-10
Pan
Fineness Modulus = (Sum of cumulative percentage retained on each sieve) / 100 =
Fineness Modulus Specified Limit : > 2.0 & < 3.5 (MORTH CL. 1008)
For Crushed stone sand (Crusher Dust), the permissible limit on 150 micron IS sieve is incresed to 20%
Remarks

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000 to km 226+500 under Raipur-
Visakhapatnam Economics Corridor in the state of Odisha on Hybrid Annuity Mode (Package – OD-3) (Length 47.500 km)

ALL-IN-AGGREGATE GRADING

Weight of Sample
Ingredient 20mm 10mm Sand Dust

(%)
Limits as per IS 383

Analysis of Aggregate fraction (% Passing) % of Different Fractions
IS Sieve Size Combined for nominal size of
(100%) 20mm aggregate
20mm 10mm Sand Dust 20mm 10mm Sand Dust (%)
40 mm 100
20 mm 95-100
4.75 mm 30-50
600 micron 10-.35
150 micron 0-6
Pan
100
90
80
70
% of Passing
60
50
40
30
20
10
0
0.1 1 10 100
IS sieve size in mm
Remarks:



: M/s SA Infrastructure Consultants Pvt. Ltd. In
COMPRESSIVE STRENGTH OF CONCRETE CUBES
Test Method: (As per IS:516)
Laboratory No. Grade of Concrete
Structure No Water - Cement Ratio
Location/ Side (LHS/RHS): Admixture
Part of Structure, Lift Date of Casting
Size of Cube Date of Testing
Volume of Cube Age in Days
Weight Average
Density of Failure Compressive
Cube of the Compressive
S.No. Cube Load Strength Remarks
No. Cube Strength
(g/cc) (kN) (N/mm2)
(g) (N/mm2)
Average compressive Strength:…………… N/mm2

Remarks:

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000 to km 226+500 under Raipur-Visakhapatnam Economics Corridor in the
COMPRESSIVE STRENGTH ON CONCRETE CORES
As Per IS 516
Laboratory No. : Date of Sampling :
Sample Details : Sampled by :
Grada of Concrete : Date of Testing :
Date of Casting : Tested by :
Avg. Corrected Equivalent

Core Core Core Comp. Correction Corrected Cyl.
Core Dia Area Volume Density Failure Load Cyl. Comp. Cube Comp.
Sl. No. Length Weight Strength l/d Ratio Factor for Comp. Strength
Strength Strength
(l/d) ratio
l cm d cm gm cm2 cm3 g/cc KN (N/mm2) (N/mm2) (N/mm2) (N/mm2)
Note:
a) For l/d ratio, correction factors are as per Figure – 1 of IS: 516 – 1959 (Reaffirmed 1999).
b) Equivalent cube compressive strength = 1.25 x corrected cylinder compressive strength as per IS: 516 – 1959 (Reaffirmed 1999).
Acceptance Criteria as per IS: 456 - 2000: Concrete in the member represented by a core test shall be considered acceptable if the average equivalent cube strength of the
cores is equal to at least 85 percent of the cube strength of the grade of concrete specified for the corresponding age and no individual core has a strength less than 75
Remark:

47.500 km)
: M/s SA Infrastructure Consultants Pvt. Ltd. In Association with ROTRANS Infra Projects Pvt.Ltd.
CONCRETE DELIVERY AND POUR CARD
Grade of Concrete : RFI NO :
Location: Date :
Part of the Structure :
Batchi Time of Slump of concrete

Time of Time of Concrete Cumulative No.of
ng Transit Mixer Dispatch (mm)
S.No Arrival at Unloaded Quantity Quantity Cubes Remarks
Plant No. from 3 3
site at site (m ) (m ) Taken
No. plant At Plant At Site

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km 179+000 to km 226+500 under Raipur-Visakhapatnam Economics Corridor in the state

DAILY CONCRETE RECIEPE / MOISTURE CORRECTION SHEET
Location : Date :
Quantity of Concrete per Batch: m3
Source of Material:
Cement:- Coarse Aggregate:-
Admixture:- Fine Aggregate:-
Absorption
Corrected
Moisture
Moisture
Content
Water
Field
Material As per Design Mix (Kg/ M3) in SSD condition Corrected Design Mix (Kg/M3)
M15 M20 M20 M20 M20 M20 M20

M25 M30 M35 M40 M45 M50 (%) (%) (%) M15 M25 M30 M35 M40 M45 M50
PCC PCC RCC KERB PCC RCC KERB
A B C D E F G H I J K L M=(L-K) M N O P Q R S T U V
Cement
Fly Ash
GGBS
Micro Silica
20 mm
10 mm
Sand
Dust
Water
Admixture
Total Design wt in Total Wt after moisture
SSD condition adjustement
Remarks:
Contractor's EPC contractor/Concessionaire's NHAI/Independent Engineer's

0 Page
47.500 km)
INDEPENDENT ENGINEER CONCESSIONAIRE EPC CONTRACTOR CONTRACTOR

M/s SA Infrastructure
Consultants Pvt. Ltd. In M/s Badakumari Karki Road : M/s Adani Road Transport
Association with ROTRANS Private Limited Limited
CONCRETE DISPATCH SLIP
Date : Grade of Concrete :
3
Name of Structure : Quantity (m ) : Cum QTY :
Structure Element : Slump (mm) :
Time of Dispatch : Vehicle No. :
Chainage : RFI No :
Plant Representative Site Representative


BAR BENDING SCHEDULE (IS: 2502)
RFI No.: Date:
Structure No. : Type of Structure:
Chainage: Part of Structure:
Carriageway / Side: Prepared By:
Dia
Bar Cut Total Unit
of Shape of Bar / Spacing No. of Total Weight
Mark Length Length Weight
Bar Designation of Bar (mm) Bars (Kg)
No. (m) (m) (Kg)
(mm)
Extra Reinforcement:
Remarks:


179+000 to km 226+500 under Raipur-Visakhapatnam Economics Corridor in the state

:M/s SA Infrastructure Consultants Pvt. Ltd. In Association with
SIEVE ANALYSIS OF FILTER MEDIA
As per MORTH CL. 309.3.2.2 (i) & TABLE 300-3

Specification Limit Table 300.3 Class -I
IS Sieve Cumulativ
Size Weight Cumulativ
e Weight Passing
(mm) Retained e Retained Lower Limit Upper Limit
Retained (%)
(g) (%)
(g)
11.2 100 100

5.6 92 100
2.8 83 100
1.4 56 96
0.71 35 80
0.355 14 40
0.18 3 15
0.09 0 5
Remarks:
EPC
Contractor's Contractor/Concession NHAI/Independent Engineer's
FSEL-1034-QAM Rev. R 0 Page

CONCESSIONAIRE
Format No. : SKRPL/QC/FM/02 R0
As per MORTH CL. 309.3.2.2 (ii) & TABLE 300-3

Specification Limit Table 300.3 Class -II
IS Sieve Cumulativ
e Weight Passing
Retained (%)
(g) (%)
(g)
26.5 100 100

22.4 95 100
11.2 48 100
5.6 28 54
2.8 20 35
0.71 6 18
0.36 2 9
0.09 0 4
Remarks:

FSEL-1034-QAM Rev. R 0 Page

CONCESSIONAIRE
Format No. : SKRPL/QC/FM/03 R0
As per MORTH CL. 309.3.2.2 (iii) & TABLE 300-3

Specification Limit Table 300.3 Class -III
IS Sieve Cumulativ
e Weight Passing
Retained (%)
(g) (%)
(g)
53 100 100
45 97 100
22.4 58 100
11.2 20 60
5.6 4 32
2.8 0 10
1.40 0 5
0.09 0 3
Remarks:

Page
226+500 under Raipur-Visakhapatnam Economics Corridor in the state of Odisha on Hybrid

Projects Pvt.Ltd.
SIEVE ANALYSIS OF PAVEMENT CONCRETE (DLC )
As per MORTH TABLE 600-1 Grading 1
Proposed Use: Tested by
Wt. of Sample
Cumulative Cumulative
Weight Passing
Weight Retained
Retained (g) (%)
IS Sieve Size Retained (g) (%) Specification Limit
26.5mm 100
19.0mm 75-95
9.5mm 50-70
4.75mm 30-55
2.36mm 17-42
0.600mm 8-22
0.300mm 7-17
0.150mm 2-12
0.075mm 0-10
Pan
Remarks :

Representaive Representative Representative
Page
226+500 under Raipur-Visakhapatnam Economics Corridor in the state of Odisha on Hybrid

Projects Pvt.Ltd.
EPC CONTRACTOR: : M/s Adani Road Transport Limited
SIEVE ANALYSIS OF PAVEMENT CONCRETE (PQC)
As per MORTH TABLE 600-3 Grading 1
Proposed Use: Tested by
Wt. of Sample
Cumulative Cumulative
Weight Passing
Weight Retained
Retained (g) (%)
IS Sieve Size Retained (g) (%) Specification Limit
31.5mm 100
26.5mm 85-95
19.0mm 68-88
9.5mm 45-65
4.75mm 30-55
0.600mm 8-30
0.150mm 5-15
0.075mm 0-5
Pan
Remarks :

Representaive Representative Representative
Page
226+500 under Raipur-Visakhapatnam Economics Corridor in the state of Odisha on Hybrid Annuity
Mode (Package – OD-3) (Length 47.500 km)
Projects Pvt.Ltd.
FLEXURAL STRENGTH OF CONCRETE
(As per IS -516)
Laboratory Grade of Concrete
Location Water - Cement Ratio
R-7(Ratio of 7 to 28 days FS) Date of Casting
Quantity of Concrete (M3) Date of Testing
Age in Days
Average Flexural 28 days equivalent

Beam Dimensions of Beam Crack Length Failure Load Flexural Strength Strength Flexural Strength
No. (mm x mm x mm) (mm) (kN) (N/mm2) 2 2
(N/mm ) (N/mm )
Average Flexural Strength:…………… N/mm2
Remarks:


GRID LEVEL SHEET
RFI NO:
Structure No: Date:
Chainage: OGL :
Side: RL of TBM:
Part of Str: Target RL:
TBM No: Prepared By:
1 2 3 4
5 6 7 8
9 10 11 12
13 14 15 16
Mean / Average Level:

Remarks:

Page

LEVEL SHEET
RFI No. : Layer Name Side Date
Offsets
Chainage FRL Camber Description Remarks
IS
Achieved level
Design level
Difference
IS
Achieved level
Design level
Difference
IS
Achieved level
Design level
Difference
IS
Achieved level
Design level
Difference
IS
Achieved level
Design level
Difference
IS
Achieved level
Design level
Difference
IS
Achieved level
Design level
Difference

Government of India
CONCESSIONAIRE
LEVEL SHEET
Name of layer :
TBM NO : RFI No :
TBM RL : Date :
BS : Chainage :
HI : Side :
Offset @ FRL
Chainage FRL Camber Description Offsets Remarks
IS
Achieved
Designed
Diff. (mm)
Offset
IS
Achieved
Designed
Diff. (mm)
Offset
IS
Achieved
Designed
Diff. (mm)
Offset
IS
Achieved
Designed
Diff. (mm)
Offset
IS
Achieved
Designed
Diff. (mm)
Offset
IS
Achieved
Designed
Diff. (mm)
Offset
IS
Achieved
Designed
Diff. (mm)

Page

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Format No : ARTL/BKRP/F/01 Rev 0

Client : : National Highways Authority of India

Independent Engineer : : M/s SA Infrastructure Consultants PVT LTD

Concessionaire : : M/s Badakumari Karki Road Private Limited

EPC Contractor : : M/s Adani Road Transport Limited

REQUEST FOR INSPECTION (RFI)

RFI NO. Date :

Location / Chainage : Side :

Remarks / Comments / Observations / Remedial Action given by NHAI / IE

Client : National Highways Authority of India

Contractor EPC Contractor/Concessionaire NHAI/Independent Engineer

CLIENT : National Highway Authority Of India

Contractor EPC Contractor/Concessionaire NHAI/IE

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km

Client : National Highways Authority of India

Laboratory No. : Date of testing :

6. Bulk Density of Sand Y = Wa/V (g/cc)

Contractor's EPC Contractor/ Concessionaire's NHAI/Independent Engineer's

RMM Reading Vs Moisture Content

Contractor's EPC Contractor/Concessionaire's NHAI/Independent Engineer

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from

CLIENT : National Highways Authority of India

Acceptable Variation as per MORTH, Cl. 1707

Contractor's EPC Contractor/Concessionaire's NHAI/Independent Engineer's

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from

CLIENT : National Highways Authority of India

Make Plant Location

Recommended Tolerance as per IS 3066 Clause 14.3.1 Bitumen ± 2% Max.

Contractor's EPC Contractor/Concessionaire NHAI/Independent Engineer's

Plant ID/ Make: Date of Calibration:

Plant Location: Due date:

Length of Gethering Belt : m

Time of 5 Revoulutions of belt : sec

Time of 1 Revoulutions of belt : sec

Speed of the Belt : m/sec

Contractor's EPC Contractor/Concessionaire's NHAI/Independent Engineer's

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km

Client : National Highways Authority of India

Capacity Due Date of Calibration

Actual Capacity of Plant TPH

Take Efficiency of Plant %

Runing Capacity of Plant TPH

Length of the Gathering Belt Metre

Avg. Time taken for10 Revolutions of the Belt Sec

Ave time taken for 1 revolution of the belt Sec

Speed of the Belt per Sec m/sec

Speed of the Belt per Hour m/hr

Estimated qty for 1m length of belt sample Kg/mt

WMM Plant Bin No. 1 2 3 4 Water Cell

Size of Aggregates (mm) Dust 10mm 20mm 40mm Water

Mix Proportion (%)

Required Qty (200 TPH)

Required Load Setting (%)

Contractor's EPC Contractor/Concessionaire's NHAI/Independent Engineer's

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from

Client : National Highways Authority of India

Source of Material Date of Calibration

Location Due Date of Calibration

Contractor's EPC Contractor/Concessionaire's NHAI/Independent Engineer's

Development of Six Lane Badakumari – Karki Section of NH-130-CD Road from km

Client : National Highways Authority of India

Source of Material Date of Calibration

Location Due Date of Calibration