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G&B-104 (02/21118) <br />M V011 }.1 <br />CERTIFICATION OF AGGREGATES AND <br />b 4 <br />0 <br />GRANULAR MATERIALS <br />fiy} of Tf1r¢ <br />Project o: <br />Contractors Tester Name: <br />Tim Mueller <br />Tester Certification No (If Required): <br />15465 <br />Submitted y:Fn-meContractor) <br />ubmitted o: (PRO-1ectEngineer) <br />Source or Stockpile Location: <br />Barton Sand & Gravel - 8000 Zachary lane Maple Grove, Mn <br />I certify that these materials to be delivered to this project conform to the appropriate specification requirements. (Type/Print Name) <br />Certified by: (Contractor's Authorized Representative Signature) <br />pate: <br />Pay Item Number <br />Class or Type of <br />Aggregate <br />Quantity <br />Gradation Tests (if required) <br />Required <br />Attached <br />3126 washed sand <br />241 <br />Crushing Tests (N Required) <br />Quality Tests (if Requied) (LAR, Shale, Bitumen, IR, etc.) <br />Required Attached <br />Required <br />Attached <br />Note: <br />NOTE: Attach Required test results (gradations, crushing, bitumen content, qualities, etc.), per <br />the Schedule of Materials Control, plan or proposal, etc. Send cony to Proiect Engineer. <br />Complete below if salvaged/recycled materials are being used: <br />Type or Class of Aggregate Bitumen content of the composite mixture: % <br />Bituminous % Concrete % Glass % <br />Specification Gradation Table for 3138 (3138-3, 3138-0, or 3138-5) <br />Based upon the percentage of recycled material specified above <br />