Form 253 - Daily Report Portland Cement Concrete Ncdot

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NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
DAILY REPORT ON PORTLAND CEMENT CONCRETE PAVEMENT
ROADWAY INSPECTOR’S REPORT
CONTRACT NO.:
COUNTY:
DATE:
WEATHER:
TEMPERATURE– HIGH:
DIVISION:
CONTRACTOR (PRIME):
LOW:
REPORT NO.
CONCRETE MIX DESIGN:
PAVING CONTRACTOR:
RE OFFICE:
STAKING
METHOD OF BAR
VIBRATOR
PINS
NO. OF TRUCKS:
TINING / CURING:
INSTALLATION:
FREQUENCY: (VPM)
CORRECTLY
(BASKET, DBI)
INSTALLED:
MIXER:
TYPE OF CURING:
AGITATOR:
BEGIN:
TOTAL AREA:
NON-AGITATOR:
MIDDAY:
GALLONS USED:
END:
AVERAGE
ROUNDTRIP:
RATE OF APPLICATION:
PLAN
SIZE OF
FROM
LINEAR
WIDTH
SQUARE
CUBIC
LANE/
NO. OF
TO
DEPTH
BATCHES
STATION:
STATION:
FEET:
(FEET)
YARDS:
YARDS:
SHOULDER:
BATCHES:
(FEET):
(CU. YDS.)
TODAY’S
TOTALS:
NOTE: WHEN MORE THAN ONE DEPTH OF CONCRETE IS PLACED, SHOW THE NUMBER OF SQUARE YARDS, AND DEPTH USED FOR EACH
DIFFERENT DEPTH. SHOW EQUALITIES AND OTHER DEDUCTIONS OR ADDITIONS TO THE NEAREST LINEAR FOOT.
Method -
Time of
No. of Joints
Batch Ticket
Concrete
Discharge
Protect
Avg. Depth of
Air Content:
Slump:
Station:
Initial
Checked
Time:
Temperature:
Time:
Existing
Saw Cut:
Cut:
(20% min)
Joints
Tining
Curing
Joints
Are locations for
Is curing Full
Jt.s clearly
Depth:
Coverage
marked:
What is the
Are Jt.s aligned
Spacing:
Appli.Rate:
with Adj. Jts.:
What was the
Are Jt. Cuts
Width:
Time of Appli.
Raveling:
Has Curing been
Uniform Appearance:
reapplied:
Microtexture (burlap,
etc.:
*Technician Signature: __________________________________
* PCCP Certification Number:______________________________________
*By providing this data under my signature and/or HiCAMS certification number, I attest to the accuracy and
validity of the data contained on this form and certify that no deliberate misrepresentation of this data in any
manner has occurred.
Distribution: Materials and Tests Unit, Pavement Construction Section, Division Engineer, Resident Engineer

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