SMPL_-_3_Sample_Project_WWYK100217__Submittal_Form_66.pdf

SCHEDULE OF MATERIAL SUBMITTALS

PROJECT NUMBER PROJECT TITLE SOLICITATION/CONTRACT NUMBER

WWYK 100217 REPAIR RAPCON RD FROM

RESERVE RD TO PATROL RD

TO BE COMPLETED BY PROJECT ENGINEER TO BE COMPLETED BY CONTRACT ADMINISTRATOR

LI

N

E N

U M

BE

R

ITEM OR DESCRIPTION OF ITEM, CONTRACT

REFERENCE, TYPE OF SUBMITTAL

NUMBER OF COPIES REQUIRED

R

EQ

U

IR

ED

S

U

BM

IS

SI

O N

D

AT

E

D

AT

E R

EC

EI

V

ED

IN

C

N

TR

AC

TI

G

E

TO

C

IV

IL

EN

IN

EE

R

ET

U R

N S

U

SP

EN

S

E D

E

SU

BM

IT

TA

L N

U M

BE

S

DATE

CONTRACTOR

NOTIFIED

C O

N

TR

AC

TO

R S

U

BM

IT

TA

L

FI

N

AL

A

PP

R

O

VA

L

REMARKS

PR

EC

O N

ST

R

U C

TI

SH

P D

R

AW

IN

PR

D U

C T

D

AT

A

SA

M

PL

ES

IG

N

D

A

TE

ST

R

EP

O

TS

ER

TI

FI

C

M

AN

U

FA

C

TU

R

’S

R U

C

TI

O N

S

M

AN

U

FA

C

TU

R

FI

EL

D R

EP

O

PE

R

AT

IO

N

A

AI

N

TE

N

AN

C E

D

LO

SE

O

U T

APPROVED DISAPPROVED

Section 00700

Para. 1.2 SD-11 Attachment 2 DD Form 1354 Checklist

Para. 1.2 SD-11 Working As-Built Drawings (Redlines)

Final As-Built Drawings (Electronic)

Final As-Built Drawings (Hard Copy)

Section 00710

Para. 1.2 SD-01 (Also 00710, Para. 1.2) Contractor Health and Safety Plan.

Section 00720

Para. 1.2 SD-01 (Also 00720, Para. 1.3.3.2) Storm Water Pollution Prevention Plan

Para. 1.2 SD-01 (Also 00720, Attach 5, Para 1.2.3) Construction Debris Analysis Plan

AF FORM 66 (Rev), 19891001 (EF-V1) Page 1 of 3 Revision Date: 01 May 04

1155531637C Typewritten Text SMPL - 3 Sample Project WWYK100217 SUBMITTAL FORM 66 FA8101-15-R-0001

WWYK 100217 REPAIR RAPCON RD FROM

RESERVE RD TO PATROL RD

TO BE COMPLETED BY PROJECT ENGINEER TO BE COMPLETED BY CONTRACT ADMINISTRATOR

LI

N

E N

U M

NUMBER OF COPIES REQUIRED

R

EQ

U

IR

ED

S

U

BM

IS

SI

E

D

AT

E R

EC

EI

V

N

TR

AC

TI

E

TO

C

IN

EE

R

U R

N S

U

SP

EN

S

E D

IT

TA

L N

U M

BE

NOTIFIED

C O

N

TR

AC

TO

R S

U

BM

IT

TA

L

FI

N

AL

A

PP

R

O

VA

L

REMARKS

PR

EC

O N

ST

R

U C

TI

P D

R

AW

IN

D U

C T

D

AT

A

SA

M

IG

N

D

R

EP

O

TI

FI

C

U

FA

C

TU

R

R U

C

TI

O N

S

M

AN

U

FA

C

TU

R

D R

EP

O

R

AT

IO

N

A

N

TE

N

AN

C E

D

SE

O

U T

APPROVED DISAPPROVED

Para. 1.2 SD-01 (Also 00720, Para 1.4) Chem/Haz Matl. Req/Auth (AF Form 3952)

Electronically submitted prior to usage.

Para. 1.2 SD-07 Attachment 1 (Also 00720, Para 1.4) Monthly Hazardous Chemical Usage Report

Electronically submitted monthly.

Para. 1.2 SD-08 (Also 00720, Para 1.4) Material Safety Data Sheet

Notice of Termination (ODEQ Form 640-572)

SECTION 02551

Asphalt Mix Design & Field Test Reports

4 4 4

SECTION 02583

Fabric Reinforcement for Asphalt Pavements.

4 4

SECTION 03000

Concrete Mix Design & Test Reports (Curb & Gutter & Flumes)

4 4 4

SECTION 03200

Reinforcing Steel (Flumes)

AF FORM 66 (Rev), 19891001 (EF-V1) Page 2 of 3 Revision Date: 01 May 04

1155531637C

WWYK 100217 REPAIR RAPCON RD FROM

RESERVE RD TO PATROL RD

TO BE COMPLETED BY PROJECT ENGINEER TO BE COMPLETED BY CONTRACT ADMINISTRATOR

LI

N

E N

U M

NUMBER OF COPIES REQUIRED

R

EQ

U

IR

ED

S

U

BM

IS

SI

E

D

AT

E R

EC

EI

V

N

TR

AC

TI

E

TO

C

IN

EE

R

U R

N S

U

SP

EN

S

E D

IT

TA

L N

U M

BE

NOTIFIED

C O

N

TR

AC

TO

R S

U

BM

IT

TA

L

FI

N

AL

A

PP

R

O

VA

L

REMARKS

PR

EC

O N

ST

R

U C

TI

P D

R

AW

IN

D U

C T

D

AT

A

SA

M

IG

N

D

R

EP

O

TI

FI

C

U

FA

C

TU

R

R U

C

TI

O N

S

M

AN

U

FA

C

TU

R

D R

EP

O

R

AT

IO

N

A

N

TE

N

AN

C E

D

SE

O

U T

APPROVED DISAPPROVED

SECTION 02722

Aggregate Base

17 SECTION 03382

Joint Sealant

4 4

SECTION 09910

Pavement Striping, Thermoplastic

19 SECTION 02922

Sod

4 4

SECTION 15100

Traffic Control Plan, includes signs & barricades & Detour’s

SECTION 02558

Bituminous Tack Coat

AF FORM 66 (Rev), 19891001 (EF-V1) Page 3 of 3 Revision Date: 01 May 04

1155531637C