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G&B-104 (02121118) <br />OW i If ,�NaT4, CERTIFICATION OF AGGREGATES AND <br />a os <br />a <br />GRANULAR MATERIALS <br />of ,,Pa <br />Project o: <br />Contractor's Tester Name: <br />Tim Mueller <br />Tester Certification No (If Required): <br />15465 <br />Submitted y: nmeContractor) <br />Submitted o:(Project ngineer <br />Source or Stockpile Location: <br />Barton Sand & Gravel, 5000 Zachary Lane N Maple Grove, MN <br />T 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 />Date: <br />Pay Item Number <br />Class or Type of <br />Aggregate <br />Quantity <br />Gradation Tests (If required) <br />Required <br />Attached <br />Washed - <br />rock <br />90 <br />Crushing Tests (If Required) <br />Quality Tests (If Requied) (LAR, Shale, Bitumen, IR, etc.) <br />Required Attached <br />Required Attached <br />Note: <br />(VOTE: Attach Required test results (gradations, crushing, bitumen content, qualities, etc,), per <br />the Schedule of Materials Control, plan or proposal, etc. Send copy to P <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, 3138-4, or 3138-5) <br />Based upon the percentage of recycled material specified above <br />