Cdot Form 58 - Colorado Department Of Transportation - Field Report Of Asphalt Content And Maximum Specific Gravit (Rice) Of Hot Mix Asphalt
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1Field Sheet #
Contract ID
Date Submitted
COLORADO DEPARTMENT OF TRANSPORTATION
FIELD REPORT OF ASPHALT CONTENT
Project No.
AND MAXIMUM SPECIFIC GRAVITY
Project Location
(RICE) OF HOT MIX ASPHALT
CDOT Form #43 number:
Asphalt mix formula reference:
CDOT Form #43 date:
Region
% recycled
Report #/ Page #
Item #
Grading
CP 85 (nuclear) __________________ CP-L 5120 (ignition) ___________________ Other ____________________
Job mix formula percent AC
Range
Final report
yes
no
SMM/LIMS Sample ID
Max Specific
Fractured
Percent
User ID
Station or location
Gravity (RICE -
asphalt
(or Test # [Date])
faces
CP 51)
QA Test
IA Test
Specification deviation
no
yes
% Voids
P=________% for tests__________ thru__________
VMA
VFA
Stability
Action taken:
QA Tester (print name)
Title
IA Tester (print name)
Title
Approved by (sign name)
Title
Distribution: Original: Project file
Canary: Region Materials Engineer
CDOT Form #58
Previous editions are obsolete and may not be used
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