Contractor Name Here

Document Number Document Type Contract Number

Utilized by Contractor Logo Here
Doucment Title Issued by
Revision Number Issue Date Start Date End Date

Checklist Checklist APPROVED DATE DISCIPLINE

Final Fill Inspection

PROJECT TITLE: WBS CONTRACTOR/SUBCONTRACTOR

WIR No

ITEM NO. Check Points Reference Pass Fail Not Applicable Re-Inspection

Cohesive fill under footings, grade beams, mats, buildings and process areas shall
1.0 have been compacted to at least 90% of Modified Proctor Density to ASTM D1557 or
per project requirements, whichever is higher.

Cohesionless fill under footings, grade beams, mats, buildings and process areas shall
2.0 have been compacted to 70% relative density per ASTM D4253 and D4254 or per
project requirements, whichever is higher.

Fill under foundations with loads exceeding 320kPa (6500psf), vibrating or heavy
equipment and pavements shall have been compacted to 85% of relative density for
3.0
Cohesionless soils or 95% of maximum density per ASTM D1557 or per project
requirements, whichever is higher.

Fill Material' shall be used for all fills except where 'Select Fill Material' is specified. As
a minimum, 'Select Fill Material' shall be used within 0.6 m (2 ft) of the bottom
4.0 elevation of foundations, spread footings, or slabs-on-grade when fill is required to
achieve final grade. 'Select Fill Material' shall also be specified for backfill which will be
in contact with concrete or steel structures.

Remarks

PM/Contractor

Contractor Construction Third Party (if applicable)

The work is ready for inspection Document Reviewed Work Inspected Test Records Verified

Name Signature Date Name Signature Date

Contractor QC Inspector

The work is ready for inspection Document Reviewed Work Inspected Test Records Verified

Name Signature Date Name Signature Date

Form Ref. No. QD0002-ADM-TEM-QTY-00003– Rev.0A

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