A02_Wapp FAC Appendices 25AUG2023 (2 of 3).pdf

APPENDIX 1-B

APP CHECKLIST & AHA

Item Description Yes No N/A

1. Signature sheet

a. Includes the name, signature, and title of the Plan Preparer (Qualmed person, i.e. corporate safety staff person, QC)

b. Includes the name, signature,and tiUe of the Plan Approver {e.g.

owner, company president, regional vice presiden

c. Includes the name{s), signature(s), and title{s) for Plan Concurrence (provide concurrence of other applicable corporate and project personnel(contractor))

2.Background information

a. Includes the Contractor Name.

b. Includes the Contract Number.

c. Includes the Project Name.

d. Includes the Brief Project Description.

e. Includes the Location of the Project {map).

f. Includes a means to evaluate the work being done (see AHA requirements in 01.A.13) and associated hazards involved.

g. Addresses the identified hazards involved and the control measures to be taken.

3. Statement of Safety and Health Policy detailing their commitment to providing a safe and healthfulworkplace for all employees.

4.Responsibilities and Lines of Authorities a.Includes the identification and job responsibilities of personnel responsible for safety - at both corporate and project level - including their resumes.

b.Includes the lines of authority.

5. Training- new hire SOH orientation training at the time of initial hire of each new employee and any periodic retraining/recertification requirements 6.Procedures for job site inspections - assignment of responsibilities and frequency CESO Checklist A-01,Sep 14

U.S.Army Corps of Engineers Safety Inspection Checklist

Abbreviated Accident Prevention Plan

Inspector Name (Print) Inspector Signature

This checklist serves as a guide only. It does not replace or eliminate the need to comply with the requirements set forth in Engineering Manual 385-1-1, Safety and Health Requirements Manual, dated XX September 2014.The references Included In this checklist correspond to the applicablesections of EM 385-1-1.

If service, supply and R&D contracts with limited scopes are awarded, the contractor may submit an abbreviated Accident Prevention Plan. This APP shall address the following areas at a minimum. If other areas of the EM 385-1-1 are pertinent to the contract, the contractor must assure these areas are addressed as well.

Remarks (Any NO or N/A Item)

Date of Inspection

Location (Plant or Facility) Contract Number

Contractor Name Project Name

Date of Inspection

7.Procedures for reporting man-hours worked and reporting and investigating any accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative

(CO/COR).

8.Emergency Planning. Employees working alone shall be provided an effective means of emergency communication. This may be cellular phone, two-way radio or other acceptable means. The selected means of communication must be readily available and must be in working condition.

9.Drinking Water provisions, toilet and washing facilities.

10.First Aid and CPR training (at least two employees on each shift shall be qualified/certified to administer first aid and CPR) and provision of first aid kit (types/size).

11.Personal Protective Equipment

a. Work Clothing - Minimum Requirements. Employees to wear clothing suitable for the weather; minimum requirements for work shall be short-sleeve shirt, long pants (excessively long or baggy pants are prohibited) and leather work shoes. If AHA determines safety-toed (or other protective) footwear is necessary (i.e., mowing, weed eating, chain saw use, etc), they shall be wom.

b.Eye and Face Protection. Eye and face protection shall be worn as determined by an analysis of the operations being performed HOWEVER, all involved in chain saw use, chipping,stump grinding, pruning operations, grass mowing, weed eating and blowing operations shall be provided safety eyewear (Z87.1) as a minimum.

c. Hearing Protection. Hearing protection must be worn by all exposed to high noise activities {includes grass mowing/trimming, chainsaw operations, tree chipping, stump grinding and pruning) d.Head Protection. Hard hats shall comply with ANSIZ89.1 and shall be wom by all workers when a head hazard exists. At a minimum, hard hats shall be worn when performing activities identified in {b) above e.High Visibility Apparel shall comply with ANSI/ISEA 107, Class 2 requirements at a minimum and shall be worn by all workers exposed to vehicular or equipment traffic.

f.Protective Leg chaps shall be wom by all chainsaw operators.

g. Gloves of the proper type shall be worn by persons involved in activities that expose the hands to cuts,abrasions, punctures, bums and chemicalirritants.

h. If work is being performed around water and drowning is a hazard, PFD's must be provided and worn as appropriate.

12.Machine Guards and safety devices. Lawn maintenance equipment must have appropriate guards and safety devices in place and operational.

CESO Checklist A-01,Sep 14

U.S.Army Corps of Engineers Safety Inspection Checklist

Abbreviated Accident Prevention Plan Remarks (Any NO or N/A item)

13. Hazardous Substances. When any hazardous substances are procured, used, stored or disposed, a hazard communication program must be in effect and MSDSs shall be available at the worksite. Employees shall have received training in hazardous substances being used. When the eyes or body of any person may be exposed to corrosives, irritants or toxic chemicals, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within 10 seconds of the worksite.

14. Traffic control shall be accomplished in accordance with DOrs

MUTCD.

15. Control of Hazardous Energy (Lockout/Tagout). Before an employee perfonns any servicing or maintenance on any equipment where the unexpected unergizing or startup of the equipment could occur, procedures must be in place to ensure adequate control of

16. Driving, working on (i.e., working with equipmenUmowers) while on slopes, working from/in boats/skiffs, etc shall also be considered and dealt with accordingly.

Other Remarks

CESO Checklist A-01,Sep 14

Remarks (Any NO or N/A Item)

U.S.Army Corps of Engineers Safety Inspection Checklist

Abbreviated Accident Prevention Plan

1. Signature sheet

a. Includes the name, signature, and title of the Plan Preparer (Qualified person, i.e. corporate safety staff person, QC )

b. Includes the name, signature, and title of the Plan Approver (e.g. owner, company president, regional vice president ) (HTRW activities require approval of a Certified Industrial Hygienist, a Certified Safety Professional may approve the plan for operations involving UST removal where contaminants are known to be petroleum, oils, or lubricants).

c. Includes the name(s), signature(s), and title(s) for Plan Concurrence (provide concurrence of other applicable corporate and project personnel (contractor)) (e.g. Chief of Operations, Corporate Chief of Safety, Corporate Industrial Hygienist, project manager or superintendent, project safety professional, project

QC. )

2. Background information

a. Includes the Contractor Name.

b. Includes the Contract Number.

c. Includes the Project Name.

d. Includes the Brief Project Description.

e. Includes the Location of the Project (map).

f. Includes the Contractor Accident Experience (Copy of OSHA

g. Includes the Listing of Phases of Work and Hazardous Activities Requiring an Activity Hazard Analyses (AHA).

3. Statement of Safety and Health Policy. Includes a copy of the corporate safety policy. (In addition to the corporate policy statement, a copy of the corporate safety program may provide a portion of the information required by the accident prevention

4. Responsibilities and Lines of Authorities

a. Includes the identification and job responsibilities of personnel responsible for safety - at both corporate and project level – including their resumes.

b. Includes the lines of authority.

CESO Form A-02 Sep 13

Remarks (Any NO or N/A item)

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist

Date of Inspection

Location (Plant or Facility) Contract Number

Contractor Name Project Name

Inspector Name (Print) Inspector Signature

This checklist serves as a guide only, it does not replace or eliminate the need to comply with the requirements set forth in Engineering Manual 385-1-1, Safety and Health Requirements Manual, dated XX Sept 2014. The references included in this checklist correspond to the applicable sections of EM 385-1-1.

5. Training

a. Includes the list of subjects to be discussed with employees at safety indoctrination.

b. Includes the list of mandatory training and certifications applicable to this project (e.g., explosive actuated tools, confined space entry, crane operator, diver, vehicle operator, HAZWOPER training and certification, PPE ) and any requirements for periodic retraining / recertification.

c. Includes the identity requirements for emergency response training.

d. Includes the outline requirements (who attends, when given, who will conduct, etc. ) for supervisory and employee safety

6. Safety and Health Inspections

a. Includes the name(s) of individual(s) responsible for conducting safety inspections. (e.g., PM, safety professional, QC, supervisors, employees )

b. Includes proof of inspector's training / qualifications.

c. Indicates when inspections will be conducted.

d. Furnished sample forms upon which inspections will be recorded.

e. Indicates deficiency tracking system and follow-up procedures.

f. Includes the names of competent and / or qualified person(s) and proof of competency / qualification to meet specific OSHA competent / qualified person(s) requirements.

g. Includes any external inspections / certifications which may be required. (e.g., US Coast Guard )

7. Safety and Health Expectations, Incentive Programs, and Compliance

a. Includes the company's written safety program goals, objectives, and accident experience goals.

b. Includes a brief description of the company's safety incentive programs (if any ).

c. Includes the policies and procedures regarding noncompliance with safety requirements (to include disciplinary actions for violation of safety requirements).

d. Includes the written company procedures for holding managers and supervisors accountable for safety.

8. Mishap Reporting

a. The plan identifies how, when, and who shall complete the Exposure data (man-hours worked).

b. The plan identifies how, when, and who shall complete mishap investigations, reports, and logs.

c. The plan identifies how, when, and who shall make immediate notification of major mishaps.

CESO Form A-02 Sep 13

Remarks (Any NO or N/A item)

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

9. Plans (Programs, Procedures) required by the Safety Manual

a. Fatigue Management Plan (01.A.20)

b. Emergency response plans:

(1) Procedures & Test (01.E.01)

(2) Spill Plans (01.E.01, 06.A.02)

(3) Fire Fighting Plan (01.E.01; 19.A)

(4) Posting of Emergency Telephone Numbers (01.E.05)

(5) Man overboard/abandon ship (19.A.04)

(6) Medical Support. Outline on-site medical support and off-site medical arrangements including rescue and medical duties for those employees who are to perform them, and the name(s) of on-site Contractor personnel trained in first aid and CPR. A minimum of two employees shall be certified in CPR and first-aid per shift/site (Section 03.A; 03.D)

c. Plan for prevention of alcohol and drug abuse (01.C.02)

d. Site Sanitation Plan (Section 02.B)

e. Medical Support Plan, (03.A.01; 03.A.06; 03.D)

f. Bloodborne Pathogen Plan (03.A.05)

g. Exposure Control Plan (03.A.05)

h. Site Layout Plan (04.A)

i. Access/Haul road Plan (04.B)

j. Hearing Conservation Program (05.C)

k. Respiratory Protection Plan (05.G)

l. Health Hazard Control Program (06.A)

m. Process Safety Management Plan (06.B.04)

n. Lead Abatement Plan (06.C & Specs)

o. Asbestos Abatement Plan (06.C & Specs)

p. Radiation Safety Program (06.F)

q. Abrasive Blasting Plan (06.I)

r. Heat/Cold Stress Monitoring Plan (06.J)

s. Indoor Air Quality Management Plan (06.L)

t. Mole Remediation Plan (06.L.04)

u. Chromium (VI) Exposure Evaluation (06.M)

v. Crystalline Silica Assessment (06.N)

w. Lighting Evaluation (07.A)

x. Lighting Plan for Night Operations (07.A.09) CESO Form A-02 Sep 13

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans may include but not be limited to:

9. Plans (Programs, Procedures) continued.

y. Traffic Control Plan (08.C.05)

z. Fire Prevention Plan (09.A.01)

aa. Wild Land Fire Management Plan (09.L)

bb. Arc Flash Hazard Analysis (11.B)

cc. Assured Equipment Grounding Control Program (AEGCP), (11.D.05, App D)

dd. Hazardous Energy Control Plan, (12.A.01)

ee. Standard Pre-Lift Plan (LHE) (16.A.03, 16.L.15)

ff. Critical Lift Plan – LHE (16.H)

gg. Naval Architectural Analysis (16.L)

hh. Contingency Plan for Severe Weather (19.A.03)

ii. Man Overboard/Abandon Ship (19.A.04)

jj. Float Plan (19.F.04)

kk. Fall Protection Program, (21.D);

ll. Demolition/Renovation Plan (to include engineering survey), (23.A.02)

mm. Rope Access Program, (24.H.02)

nn. Excavation/Trenching Plan, (25.A.01)

oo. Underground construction fire prevention and protection Plan, (26.D.01)

pp. Compressed Air Plan, (26.I.01)

qq. Formwork and Shoring Erection and Removal plan, (27.C)

rr. PreCast Concrete Plan, (27.D) ss Lift. slab plans, (27.E)

tt. Masonry Bracing Plan, (27.F.01)

uu. Steel Erection Plan, (28.B)

vv. Explosives Safety Site Plan (ESSP) (29.A)

ww. Blasting Plan, (29.A; 26.J)

xx. Underwater Dive Operations Plan, (30.A.14, 16, )

yy. Tree Felling/Maintenance Program, (31.A)

zz. Aircraft/Airfield Construction Safety & Phasing Plan, (32.A.02) aaa. Site Safety and Health Plan (HTRW), (33.B) bbb. Confined Space Entry Program, (34.A.06, 07)

10. Risk Management Processes. Detailed project-specific hazards shall be identified and controls provided via Activity Hazard CESO Form A-02 Sep 13

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans may include but not be limited to:

Other Remarks:

CESO Form A-02 Sep 13

EM 385-1-1

30 Nov 14

1-12

FIGURE 1-2

Activity Hazard Analysis (AHA)

Activity/Work Task:

__________________ Overall Risk Assessment Code (RAC) (Use highest code) Project Location:

__________________ Risk Assessment Code (RAC) Matrix Contract Number:

__________________ Severity

Probability Date Prepared:

_ _/_ _/_ _ _ _ Frequent Likely Occasional Seldom Unlikely Prepared by (Name/Title):

Catastrophic E E H H M Critical E H H M L

Reviewed by (Name/Title):

Marginal H M M L L Negligible M L L L L

Notes: (Field Notes, Review Comments, etc.)

Step 1: Review each “Hazard” with identified safety “Controls”. Determine RAC (See above) Probability: likelihood the activity will cause a Mishap (near miss, incident or accident).

Identify as Frequent, Likely, Occasional, Seldom or Unlikely.

RAC Chart

Severity: the outcome if a mishap occurred.

Identify as Catastrophic, Critical, Marginal, or Negligible

E = Extremely High Risk H = High Risk

Step 2: Identify the RAC (probability vs.

severity) as E, H, M, or L for each “Hazard” on AHA. Annotate the overall highest RAC at the top of AHA.

M = Moderate Risk L = Low Risk

Job Steps Hazards Controls RAC 1.

2.

1.

2.

1.

2.

1.

2.

Equipment to be Used Training Requirements & Competent or Qualified Personnel name(s)

Inspection Requirements

MVS Form 385-10 Proponent MVS-SO March 21, 2007

ACCIDENT PREVENTION PROGRAM

FUEL OIL TRANSFER -- FLOATING PLANT

U.S. Army Corps of Engineers, St. Louis District EM 385-1-1 (Aug 05) Section 19.A.06 (g)

1) Contractor 2) Contract Name & Number 3) Date

4) Officer in Charge of Fuel Transfer 4a) Name of Vessel 4b) Fuel to be Transferred

5) Name of Vessel 5a) Names of Qualified Tankermen 5b) Type of Certification and expiration date

6) Name of Vessel 6a) Type of fill nozzle or connection on Vessel

6b) Location of fill pipes openings

6c) Location of vents openings

7) Type, number, and size of fire fighting equipment to be available during fuel transfer operations.

8) Sequential steps to be followed when taking on fuel.

Contractor's Signature

Date

C.O. or C.O.R. Signature

Date

THIS PAGE INTENTIONALLY BLANK

APPENDIX 1-C

STONE SOURCES

November 2021

STONE SOURCES

ST. LOUIS DISTRICT

Source

No. Producer MRM* Lat. Long.

1. Tower Rock Stone Co., Ste Genevieve MO. 127.6 38N 90W

2. Plattin Quarry, Ste. Genevieve, MO. 139.0 38N 90W

3. Mississippi Lime Quarry, Ste. Genevieve, MO. 155.0 38N 90W

4. Barnhart Limestone Inc., Barnhart, MO. 156.0 38N 90W

5. Bussen Quarry, St. Louis County, MO. 168.0 38N 90W

6. Bellefontaine Quarry, 8.0** 38N 90W

Fort Bellefontaine, MO.

7. Fort Belle Quarry, Ft. Bellefontaine, MO. 7.0** 38N 90W

8. Calhoun Quarry, Batchtown, IL. 241.0 38N 90W

9. Wayne Smith Quarry, Louisiana, MO. 281.0 39N 91W

10. Anna Quarry, Anna, IL. 37N 89W

11. Bussen Quarry, Eureka, MO. 38N 90W

12. Callender Quarry, Pittsfield, IL. 39N 90W

13. Central Stone Quarry #1, Huntington, MO. 39N 91W

14. Central Stone Quarry #9, Perry, MO. 39N 91W

15. Central Stone Quarry #33, Florence, IL. 39N 91W

16. Columbia Quarry Co. #15, Cypress, IL. 37N 89E

17. Char1eston Stone Co., Charleston, IL. 39N 88W

18. Columbia Quarry #1, Columbia, IL. 38N 90W

19. Columbia Quarry #9, Dupo, IL. 38N 90W

20. Falling Spring Quarry Co., Falling Springs, IL. 38N 90W

Source

No. Producer MRM* Lat. Long.

21. Magruder Quarry, Troy, MO. 38N 90W

22. Magruder Quarry, Foley, MO. 39N 90W

23. Fred Weber Inc., Winfield MO. 38N 90W

24. Bluff City Mineral, E. Alton, IL. 38N 90W

25. Columbia Quarry Co. #7, Waterloo, IL. 38N 90W

26. Seminole Ag. Lime Co., Dexter, MO. 37N 90W

27. S-S-S Inc., New London, MO. 39N 91W

28. Southeast Missouri Stone Co., Cape Girardeau, MO. 37N 89W

29. Base Rock Mineral, Bonne Terre, MO. 37N 90W

30. Williamsville Stone Co., Poplar Bluff, MO. 36N 90W

31. Nokomis Quarry, Nokomis, IL. 39N 89W

32. Brickeys Quarry, Bloomsdale, MO. 135.8 38N 90W

33. Martin Marietta Aggregate, Perryville, MO. 37N 89W

34. Ashley Quarry, Magruder Limestone, Troy, MO 39N 91W

35. Buncombe Quarry, Marion, IL 37N 88W

36. Cave-In-Rock Quarry, Cave in Rock, IL 37N 88W

37. Shawnee Stone, LLC, Cypress, IL 37N 89W

38. Heartland Materials, Jackson, MO 37N 89W

39. Cane Creek Stone LLC, Butler County, MO 36N 90W

40. Fruitland Quarry, Cape Girardeau County, MO 37N 89W

41. Arab Aggregates, LLC, Zalma, MO 37N 90W

42. Shook Quarry, Shook, MO 37N 89W

43. Lodi Quarry, Lodi, MO 37N 90W

44. Bussen Quarry, St. Genevieve, MO 38N 90W

* Mississippi River Mile

** Missouri River Mile

APPENDIX 1-D

STANDARD TEST METHOD FOR

GRADATION

BLANK PAGE

APPENDIX 1-E

SUBMITTAL REGISTER

ENG FORM 4288-R

CONTRACT NO.

TITLE AND LOCATION

CONTRACTOR

A C T I V I T Y

N O

R A N S M I T T

L

S P E

DESCRIPTION

ITEM SUBMITTED

R A G R A P H

G

CONTRACTOR:

APPROVING AUTHORITY

MAILED

REMARKS

SCHEDULE DATES ACTION

SUBMIT

APPROVAL

NEEDED

BY

MATERIAL

T I

D

DATE

OF

ACTION

DATE FWD

TO APPR

AUTH/

DATE RCD

FROM

CONTR

TO OTHER

REVIEWER

DATE RCD

FROM OTH

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ACTION

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00 08 00 SD-01 Preconstruction Equipment List 1.1.1 Accident Prevention Program 1.16 G Marine Plant Plan/Water Safety 1.16 Statements of Required 1.31 G Insurance Stone Sources 1.36.d G SD-02 Product Data Certificates of Compliance 1.13 SDS Sheets 1.27.1 G SD-06 Test Reports Laboratory Test Reports 1.13 G Ledge Testing 1.36.f G 01 11 30 SD-01 Preconstruction Environmental Protection Plan 1.5 G 01 45 00.01 10 SD-01 Preconstruction Quality Control Plan 1.2 G 01 13 20 SD-01 Preconstruction Project Schedule 1.2 G 03 30 00 SD-01 Preconstruction

Testing Plan 3.1.12.1 G Placing 3.1.6.1 G SD-03 Product Data Air-Entraining Admixtures

2.1.7.1 G

Water-Reducing or Retarding 2.1.7.1 G Admixture

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(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r)

03 30 00 SD-03 Product Data Curing Material 3.1.9.1 G Reinforcing Material 2.1.10 G Form Material 3.1.5 G SD-04 Samples Lubricant for Preformed 2.1.14.2 G Compression Seals SD-05 Design Data Concrete Mix Proportions 2.1.7.1 G SD-06 Test Reports Premolded Expansion Joint 2.1.13 G Filler Strips Compression Seals and Joint 2.1.13 G Filler Strips Metallic Waterstops 2.1.13 G SD-07 Certificates Cementitious Materials 2.1.1 G Two Part Epoxy Grout for Conc 2.1.11 G Anchors 03 30 00.99 SD-01 Preconstruction

Testing Plan 3.8.1 G Placing 3.3.1 G SD-02 Shop Drawings Reinforcing Material 2.1.8 G Two-Part Expoxy Grout for 2.1.10 G Concrete Anchors

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03 30 00.99 SD-03 Product Data Air-Entraining Admixtures

2.1.6.1 G

Water-Reducing or Retarding 2.1.6.1 G Admixture Curing Material 2.1.4 G Reinforcing Material 2.1.8 G Form Material 2.1.7 G Non-shrink Grout 2.1.9 G SD-04 Samples Lubricant for Preformed 2.1.13.2 G Compression Seals SD-05 Design Data Concrete Mix Proportions 2.1.6.1 G SD-06 Test Reports Premolded Expansion Joint 2.1.12 G Filler Strips Compression Seals and Joint 2.1.12 G Filler Strips Metallic Waterstops 2.1.12 G SD-07 Certificates Cementitious Materials 2.1.1 G Two Part Epoxy Grout for Conc 2.1.10 G Anchors 31 00 00 SD-01 Preconstruction Fill and Backfill Operations 1.6.1.1 G Testing Plan 1.6.1.2 G

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31 00 00 SD-06 Test Reports Survey Records 1.6.1.3 G Fill and Backfill Materials 1.6.1.4 G Compaction Test 3.3.4.4 G SD-07 Certificates Contractor Furnished Borrow 1.6.1.5 G Areas Commercial Furnished Materials 1.6.1.6 G Certified Weight Tickets 1.4 G 31 05 19.13 SD-02 Shop Drawings G Installation Instructions 1.2 G SD-07 Certificates Manufacturer Certifications 1.2 G

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32 00 00 SD-02 Shop Drawings Gate Fabrication 2.7 G SD-03 Product Data

Landscape Timbers 2.3 G Paint, Sealants, Coatings 2.15 G Product Data Sheets 2.1 G Seamless Epoxy Coating 2.16 G Concrete Dome Post 2.10 G Decorative Boulder 2.13 G Engineered Wood Chips 2.11 G Hardwood Landscape Mulch 2.12 G Pump and Pipe Specifications 2.2 G SD-04 Samples Paint Color 2.15 G Engineered Wood Chips 2.11 G Hardwood Landscape Mulch 2.12 G SD-05 Design Data Concrete Mix Proportions G Concrete Dome Post 2.10 G SD-07 Certificates Certified Sand 2.4 G Engineered Wood Chips 2.11 G Certified Weight Tickets 1.4 SD-08 Manufacturer’s Instructions Paint Application Instructions 2.15

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32 01 29 .62 SD-03 Product Data Weight Bills 1.3.5 G Equipment 2.1 G SD-05 Design Data Grout Mixture 2.3.2 G SD-06 Test Reports Production Sampling and Test 3.9 Test, Inspection, Verification 2.4

Cement 2.3.2

Grout Mixture 2.3.2 G 32 22 30 SD-07 Certificates Certified Weight Tickets 1.4 G Aggregate Certificates 1.6 G 32 22 40 SD-01 Preconstruction Sources 1.4.1.2 G SD-06 Test Reports Gradation Test 2.2.2.3 Rip Rap 2.2 Evaluation Testing 2.2.2.1 Laboratory 2.2.2.1 Bedding Material 2.1.2 SD-07 Certificates Weight Tickets 1.5 Scales 2.2.2.2

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32 25 15 SD-01 Preconstruction Asphaltic Concrete Surface 2.3 G Installation Procedures Prime Coat 2.4 G Application Procedures Tack Coat 2.5 G Application Procedures Seal Coat 2.6 G Application Procedures Scrub Sealing 2.8 G Application Procedures Bituminous Fog Sealing 2.9 G Application Procedures SD-03 Product Data Prime Coat 2.4 Tack Coat 2.5 Seal Coat 2.6 Filler and Sealant 2.7 Scrub Seal 2.8 Fog Seal 2.9 Guardrail 2.10 G Traffic Paint 2.11 Parking Blocks 2.13 G SD-05 Design Data Mix Design Asphaltic Concrete 2.3 G Mix Design Seal Coats 2.6 G

SUBMITTAL REGISTER CONTRACT NO.

T I V I

A N S M I T T

R A G R A P

T I

AUTH/

DATE RCD

T I

ACTION

V C T L A O S R S I A F / I E C A R T E I V O W N R

TO

CONTR/

DATE RCD

FRM APPR

AUTH

(b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r)

32 25 15 SD-05 Design Data Mix Design Scrub Seal 2.8 G Mix Design Fog Sealing 2.9 G SD-07 Certificates Aggregate 2.1 Certified Weight Tickets 1.4 G

32 29 35 SD-03 Product Data Seed Mix 2.1.3 G

32 40 00 SD-03 Product Data Equipment Specifications 2.1-2.4 G Misc. Material Product Specs 1.5 G SD-07 Certificates Labor Licenses or Certification 2.5 G

33 05 23.13 SD-01 Preconstruction Statement of Qualifications 1.2.1 G Layout Plan 1.2.3 G SD-03 Product Data Pipe 2.1 G Tracer Wire 2.2 G SD-06 Test Reports Joint Reports 1.2.4

Fusion Technician Qualification 1.2.4

T I V I

A N S M I T T

R A G R A P

T I

AUTH/

DATE RCD

T I

ACTION

V C T L A O S R S I A F / I E C A R T E I V O W N R

TO

CONTR/

DATE RCD

FRM APPR

AUTH

(b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r)

33 11 00 SD-01 Preconstruction Contractor’s License 1.3.1.2 G Work Plan 1.6 G Approved Permits, As Applicable 1.6 SD-03 Product Data Pipe, Fitting, Joints, Couplings Various G Tapping Sleeves 2.3, 2.7 G Corporation Stops 2.2 G Disinfection Procedures 3.2.1 G Precast Concrete Manholes 2.10 G Frames, Covers, Grating 2.10.1 G SD-06 Test Reports Bacteriological Samples 3.2.1 Hydrostatic Test 3.2.4.7 Leakage Test Various Infiltration and Exfiltration Test Various Deflection Test Various Tracer Wire Continuity Test Various Manhole Testing 3.4.6 SD-07 Certificates Pipe, Fittings, Joints, Coupling Various Gaskets 1.6 33 40 00 SD-03 Product Data Culvert Pipe 2.1 G Culvert Pipe End Sections 2.2 G

APPENDIX 1-F

TRANSMITTAL FORM

ENG FORM 4025-R

TRANSMITTAL OF SHOP DRAWINGS, EQUIPMENT DATA, MATERIAL SAMPLES, OR

MANUFACTURER'S CERTIFICATES OF COMPLIANCE

For use of this form, see ER 415-1-10; the proponent agency is CECW-CE.

DATE TRANSMITTAL NO.

SECTION I - REQUEST FOR APPROVAL OF THE FOLLOWING ITEMS (This section will be initiated by the contractor)

TO:

PROJECT TITLE AND LOCATIONSPECIFICATION SEC. NO. (Cover only one section with each transmittal)

FROM: CONTRACT NO. CHECK ONE:

THIS TRANSMITTAL IS FOR: (Check one)

THIS IS A NEW TRANSMITTAL

THIS IS A RESUBMITTAL OF

TRANSMITTAL

FIO GA DA CR DA/CR DA/GA

ITEM

NO.

(See

Note 3)

USACE

ACTION

CODE

(Note 9)

SUBMITTAL

TYPE CODE

(See Note 8)

NO.

OF

COPIES

SPEC.

PARA. NO.

DRAWING

SHEET NO.

CONTRACTOR

REVIEW

CODE

VARIATION

Enter "Y" if requesting a variation

(See Note 6)

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.)

a. i.c. d. e. f. g. h.b.

CONTRACT DOCUMENT

REFERENCE

REMARKS

SECTION II - APPROVAL ACTION

I certify that the above submitted items had been reviewed in detail and are correct and in strict conformance with the contract drawings and specifications except as otherwise stated.

NAME OF CONTRACTOR SIGNATURE OF CONTRACTOR

NAME AND TITLE OF APPROVING AUTHORITY SIGNATURE OF APPROVING AUTHORITY DATEENCLOSURES RETURNED (List by item No.)

REPLACES EDITION OF MAR 95, WHICH IS OBSOLETE.ENG FORM 4025-R, MAR 2012

INSTRUCTIONS

1. Section I will be initiated by the Contractor in the required number of copies.

2. Each Transmittal shall be numbered consecutively. The Transmittal Number typically includes two parts separated by a dash (-). The first part is the specification section number. The second part is a sequential number for the submittals under that spec section. If the Transmittal is a resubmittal, then add a decimal point to the end of the original Transmittal Number and begin numbering the resubmittal packages sequentially after the decimal.

3. The "Item No." for each entry on this form will be the same "Item No." as indicated on ENG FORM 4288-R.

4. Submittals requiring expeditious handling will be submitted on a separate ENG Form 4025-R.

5. Items transmitted on each transmittal form will be from the same specification section. Do not combine submittal information from different specification sections in a single transmittal.

6. If the data submitted are intentionally in variance with the contract requirements, indicate a variation in column h, and enter a statement in the Remarks block describing he detailed reason for the variation.

7. ENG Form 4025-R is self-transmitting - a letter of transmittal is not required.

8. When submittal items are transmitted, indicate the "Submittal Type" (SD-01 through SD-11) in column c of Section I.

Submittal types are the following:

SD-01 - Preconstruction SD-02 - Shop Drawings SD-03 - Product Data SD-04 - Samples SD-05 - Design Data SD-06 - Test Reports

SD-07 - Certificates SD-08 - Manufacturer's Instructions SD-09 - Manufacturer's Field Reports SD-10 - O&M Data SD-11 - Closeout

9. For each submittal item, the Contractor will assign Submittal Action Codes in column g of Section I. The U.S. Army Corps of Engineers approving authority will assign Submittal

Action Codes in column i of Section I. The Submittal Action Codes are:

A -- Approved as submitted.

B -- Approved, except as noted on drawings. Resubmission not required.

C -- Approved, except as noted on drawings. Refer to attached comments.

Resubmission required.

D -- Will be returned by separate correspondence.

E -- Disapproved. Refer to attached comments.

10. Approval of items does not relieve the contractor from complying with all the requirements of the contract.

F -- Receipt acknowledged.

X -- Receipt acknowledged, does not comply with contract requirements, as noted.

G -- Other action required (Specify)

K -- Government concurs with intermediate design. (For D-B contracts)

R -- Design submittal is acceptable for release for construction. (For D-B contracts)

ENG FORM 4025-R, MAR 2012

APPENDIX 3-A

MODOT CURB DETAILS