FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION

FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01

Date Stamp

(a) Project Name: Project Number:

(b) Item Number: Item Description:

(c) Date work performed:

Copy Stamp

Daily Record Of Miscellaneous Items (f) Calculations*:

(g) Supporting sketch and details*:

Summary of Quantities (d) Location: (e) Measured quantity:

*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:

FHWA Use Only(i) Interim Measurement Final Measurement Verified By:

Construction Inspector

I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record

Checked By:(j) Contractor Representative FHWA Representative Date:

40101Superpave Hot Asphalt Concrete Pavement

35+840 to 34+338 (plus 3 loads for turnouts): 1187.47 t

Lot 2

See the following attachments:(a) daily mass record WFLHD 422M(b) street delivery report, spread report WFLHD 434(c) ticket check MS Excel spreadsheet

see above stations 1187.47 t

1187.5

t

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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION

FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01

Date Stamp

(a) Project Name: Project Number:

(b) Item Number: Item Description:

(c) Date work performed:

Copy Stamp

Daily Record Of Miscellaneous Items (f) Calculations*:

(g) Supporting sketch and details*:

Summary of Quantities (d) Location: (e) Measured quantity:

*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:

FHWA Use Only(i) Interim Measurement Final Measurement Verified By:

Construction Inspector

I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record

Checked By:(j) Contractor Representative FHWA Representative Date:

40105Antistrip Additive

9/11 = 26.4 tons9/14 = 28.7 tons9/16 = 27.2 tons

= 82.3 tons total

8,700.97 tons of Superpave Pavement Placed, @ 5.5% AC mix design = 8,222.41 tons of rockAntistrip Additive added at 1% per weight of rock = 82.2 tons

Invoice totals verified by weight of total tons placed

See attachments

82.3

82.3

t

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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION

FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01

Date Stamp

(a) Project Name: Project Number:

(b) Item Number: Item Description:

(c) Date work performed:

Copy Stamp

Daily Record Of Miscellaneous Items (f) Calculations*:

(g) Supporting sketch and details*:

Summary of Quantities (d) Location: (e) Measured quantity:

*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:

FHWA Use Only(i) Interim Measurement Final Measurement Verified By:

Construction Inspector

I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record

Checked By:(j) Contractor Representative FHWA Representative Date:

Be sure to check the contractors application rate

41201Tack Coat

Attached Ticket: 5.09 tons = 5.1 tons

Station 20+05 to Station 121+84 = 10,179 feet @ 12' wide = 122,148 SQ FT = 13572 SYTack applied at 0.09 gal/SY = 1221.48 gal @ 240 gal/ton = 5.0895 tons

Weigh ticket matches measured verified by measured calculations

See attachments

5.1

5.1

t

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