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CS-704 (12-19)MINIMUM QUALITY CONTROL PLAN FORFIELD PLACEMENT CONCRETE OPERATIONS(Attach additional sheets as necessary)www.penndot.govState Route (SR) Section County ECMS#Prime/Sub ContractorPart 1. ORGANIZATIONAL CHARTPersonnelFull NameResponsibilitiesA. SuperintendentOversees concrete operations.B. Concrete ForepersonOversees placement of materialand related operations.C. Certified Field Technician Performs field tests and sampling andacts as contact person to PennDOT.PennDOT Certification No.: Expiration Date:D. Technician in TrainingPerforms field tests and sampling andacts as contact person to PennDOTunder the direct supervision of acertified technician.Note: Problems related to concrete material, placement operations, and testing shall be directed to theappropriate personnel listed above.Part 2. MIXING AND DELIVERYConcrete shall be supplied from a current PennDOT approved concrete plant listed in Bulletin 42.A. Two-way communications shall be maintained between the concrete plant and the work site.B. A plant delivery slip signed by the plant technician and containing the information specified in Publication 408shall be supplied for each truck.Page 1 of 5

CS-704 (12-19)Part 3. MATERIAL CONTROLMaterial control is considered established when all tests results of concrete temperature, air, and slump ofthree consecutive trucks are determined to be within the established action points. If a test exceeds theupper or lower action points the testing frequency shall be increased to every truck until materialcontrol is reestablished and the plant technician shall be notified.A. List designs and Slump Requirements ( Attach additional sheets as necessary)ConcreteSupplierCodeJMFNumber andYearStructuralElementBeing PlacedClass ofConcreteand SlumpUpper Limit(Pub 408)SelectedTargetSlumpValueTarget Range[ /- 1 ½” max. Action Points[May not be from the1/2" from targetselected target range values]slump value]Note: Target range not to exceed upper slump limit. More stringent action points may be specified if desired.Page 2 of 5

CS-704 (12-19)B. Testing Requirements1. Temperature (ASTM C1064) Shall be performed every time air and slump tests are performed. If the actionpoints shown below are reached, the plant shall be contacted so corrective action can be taken. Additionaltests shall be performed as specified in Publication 408. Concrete that does not meet the temperaturespecification requirements shall not be incorporated.Concrete Temperature Spec. LimitsandConcrete Temperature Spec. Limits (Concrete Deck Placement)andConcrete Temperature Action PointsandConcrete Temperature Action Points (Concrete Deck Placement)and2. Slump tests (AASHTO T119) Shall be performed on the first three consecutive trucks and until materialcontrol is established. Additional tests shall be performed as specified in Publication 408. If the slump upperlimit is exceeded, the contractors’ technician SHALL reject the truck.If the District permits the addition of water to adjust for low slump concrete, specify the controls and procedurefor adding the water: (No water may be added to AAAP. Attach a comprehensive plan if water reducer is to beadded on site.)Slump specification limits and actions points are indicated in Section A shown above.3. Air test (AASHTO T152 or T196) Shall be performed on the first three consecutive trucks and until Materialcontrol is established. Additional tests shall be performed as specified in Publication 408.Concrete Air Content Spec. LimitsConcrete Air Content Spec. Limits (AAAP and Paving)Concrete Air content Action PointsConcrete Air Content Action Points (AAAP and Paving)% and %% and %% and %% and % Low air content material may be remixed at mixing speed and retested. (1 time only, not to exceed themaximum allowed time or 300 revolutions) High air content material may be allowed to mix at agitating revolutions for a period of time and re-tested.(1 time only, not to exceed the maximum allowed time or 300 revolutions) Trucks with high air content material may be pulled aside with the barrel stopped, not to exceed 45minutes, as specified in Pub. 408, Section 704.2(c). Prior to retest, the concrete is agitated for at least 20revolutions. (1 time only, not to exceed the maximum allowed time or 300 revolutions) Consult with ready-mix supplier before any of the above field adjustments are attempted. Fieldadjustments by adding water are not permitted to adjust plastic air content.(AASHTO M 157)4. List Concrete Testing Equipment (Attach additional sheets as necessary) All air meters will be calibrated prior to use and at least once every 2 weeks thereafter in the presence ofthe Inspector.Page 3 of 5

CS-704 (12-19)Part 4. CONCRETE CYLINDERSA. Number of Concrete CylindersThe following number of concrete cylinders shall be molded and cured according to PTM No. 611 for testingpurposes. Cylinders shall be identified on the outside of the mold using indelible ink and shall be capped withdomed lids:3-Day Quality Control compressive strength7-Day Quality Control compressive strength14-Day Quality Control compressive strength (AAAP)Cylinders for form removal strength ( Specify: )Cylinders for loading strength ( Specify: )28-Day Quality Control compressive strength28-Day Acceptance compressive strength56-Day Quality Control compressive strength (AAAP and Prevention Level Z mixes)56-Day Acceptance compressive strength (AAAP and Prevention Level Z mixes)The number of Verification cylinders and Quality Assurance cylinders molded shall be as specified inPublication 408 and molded and cured according to PTM No. 611.B. Curing Concrete Cylinders (Attach additional sheets as necessary)Curing and care of the concrete cylinders shall be the responsibility of the contractor.First 24 hours of curing: Cylinders shall be moved within 15 minutes of molding to the curing location. Maintain initial curing temperature for all normal strength concrete cylinders 60 F and 80 F. Describe method of curing for first 24-hours for each type of cylinder:After 24 hours of curing: Cylinders shall be stripped from the molds and the original identification shall be transferred from thecylinder mold onto the cylinder using indelible ink. Acceptance cylinders will be cured in a lime bath with a temperature of 73 /- 3 F. Describe method of curing after 24 hours for each type of cylinder: (Attach addendum for Cool and ColdWeather Curing as necessary):Page 4 of 5

CS-704 (12-19)Cylinder Transportation and Handling Describe the method of transportation and handling. Specify the location of the concrete break machine.Part 5. FIELD PLACEMENT WORKFORCE AND EQUIPMENTList workforce, equipment, and method of placement (bucket, pump etc.) for each structural element. (Attachadditional sheets as necessary)Submitted By: Date:Supplier Reviewed By:Date:Department Reviewed By: Date:Page 5 of 5

Class of Concrete and Slump Upper Limit (Pub 408) Selected Target Slump Value Target Range [ /- 1 ½” max. from the selected target slump value] Action Points [May not be 1/2" from target range values] Note: Target range not to exceed upper slump

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Government Services: North Carolina NC Department of Revenue 704-519-3000 NC Driver’s Licenses/ID Cards 704-853-5372 NC Employment Security Com-mission 704-480-5414 NC Services for the Blind 704-563-4168 NC Tags & Registration/ Handicap Placards 704-864-4856 Grocery Stores Food Lion 704-861-0

Housing & Residence Life 704-687-7501 housing.uncc.edu Student Health Center 704-687-7400 studenthealth.uncc.edu Parent and Family Programs 704-687-0341 parents.uncc.edu Office of the Registrar 704-687-5505 registrar.uncc.edu Student Computing 704-687-5500 labs.uncc.edu Office of Disability Services 704-687-4355 ds.uncc.edu

Adult Health Clinic 704-853-5006 Pharmacy 704-853-5011 Lincoln County Health Dept. 704-736-8426 302 North Academy St. Suite B, Lincolnton, NC 28092 Cleveland County Health Dept. 704-484-5000 315 E Grover St, Shelby, NC Community Foundation of Gaston Co. 704-864-0927

Elena Payne-Wiens, Assistant Dean for Advising & Assessment epaynewi@uncc.edu // 704 687 0876 // Storrs 101E Dr. Lee Gray, Senior Associate Dean 704 687 0100 (CoA A Front Office, Storrs 101) department of dance Office Robinson 360 704 687 0225 Academic Advisors »Hannah Harrell, Performing Arts // hbharrel@uncc.edu // 704 687 0472

United Way of Cleveland County 132 W. Graham St., Shelby, NC 704-482-9662 United Way of Gaston County 200 E. Franklin Blvd., Gastonia, NC Information & Referral Center 211 f or help 704-864-4554 704-482-7344 United Way of Lincoln County PO Box 234, Lincolnton, NC 28093 704-732-8055

Charlotte, NC 28273 980-613-6171 * 19588 Royal, Arlesia D 980-613-6171 4880 A-List Realty & Mortgage Svcs 5858 Cambridge Bay Drive Charlotte, NC 28269 704-622-2875 Fax: 704-522-6690 * 48803 Lee, Charles Dennis 704-622-2875 1140 A-Plus Realty, Inc. PO Box 560367 Charlotte, NC 28256 704-374-5011

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Melanie V. Powell, Ph.D. 501 S. Sharon Amity Road Suite 500 Charlotte, NC 28211 Office: 704-362-1555 x12 Appointments: 704-248-4849 Susan Williams, M.S. M.Ed 501 S. Sharon Amity Road Suite 500 Charlotte, NC 28211 704-362-1555 x15 Shaded psychologists administer WPPSI-IV and WISC-V. Non-shaded administer WPPSI-IV only.