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DAILY REPORT
CONSULTING ENGINEERS
CUENT P r' 0 IL f.da-
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TEMP. RANGE
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SERVICES
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MA TERIAL
END STA
BEGIN STA
LENGTH
DEPTH x W1DlH
CALC QUANTITY
USED QUANTITY
YlELD= USED kAle
COMMENTS:
PLAN SHEET
STREET
SN-WM-ST-FM
SIZE-MATERIAL
SOIL TYPE
SPEC. GRAN.
END STA
BEGIN ST A
LENGTH
FOREMAN
WORKERS
START TIME
END TIME
VALVES. rIIIINGS, HYDRANTS.
MANHOLES AND CATCH BASINS
Station T)1). Depth 51z.
COMMENTS:
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TOTAL HOURS 2.'1 i4
INSPECTOR . D J 1w. r '" ~
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DAILY REPORT
PAGE OF
CUENT ~~l./l- ~ PROJECT f,bl...k ~/L DATE tt'J/7fu SlotT w(!}~
CONTRACTOR (PRIME/SUB) fI-. \oJ,1 . J ~ SUPERINTENDENT 10 N\. ev" ~
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SPEC. GRAN.
END STA
BEGIN ST A
LENGTH
FOREMAN (-rA~
WORKERS . I
START TIME
END TIME
MA TERIAL
END 5TA
BEGIN 5T A
LENGTH
DEPTH x WIDTH
CALC QUANTITY
USED QUANTITY
YlELD= USED kALe
COMMENTS:
VALVES. FlTnNGS. HYDRANTS.
MANHOLES AND CATCH BASINS
station T)1)e Depth Size
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White - Office
Yellow - Inspector
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DAILY REPORT
CUENT -koTL ~
CONTRACTOR (PRIME/SUB)
lEMP. RANGE -/0 U
PAGE OF
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~ SUPERINTENDENT t: I~
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END STA
BEGIN STA
LENGTH
DEPTI-l x W1DTI-l
CALC QUANTITY
USED QUANTITY
YlELD= USED kALe
COMMENTS:
PLAN SHEET
STREET
SN-WM-ST-FM
SIZE-MATERIAL
SOIL TYPE
SPEC. GRAN.
END STA
BEGIN STA
LENGTH
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START TIME
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DAILY REPORT
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TEMP. RANGE ;;>- DS
PAGE Of
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END STA
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FOREMAN
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START TIME
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MA TERIAL
END STA
BEGIN STA
LENGTH
DEPTI-l x W1DTI-l
CALC QUANTITY
USED QUANTITY
YlELD= USEO~AlC
COMMENTS:
VALVES, f1T11NGS. HYDRANTS.
MANHOlES AND CATCH BASINS
Station T)1)e Depth Size
,-
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COMMENTS: W /' w- ~ ~e,/ ~ <.'
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DAILY REPORT
PAGE OF
CUENT Pd1()/?- hak PROJECT tk ~ 'U.. DATEL/L\ /q. L S M T w(!): S
CONTRACTOR (PRIME/SUB) 4A-r/~, SUPERINTENDENT 7D~ .K~A,J
TEMP. RANGE 1-7 - I) . WIND /0 -I r CLOUD COVER ,-1c{J~/!'y PREClPITAnON .(tVOfwtr
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I END STA
BEGIN STA
LENGTH
DEPlH x W1DlH
CALC QUANTITY
USED QUANTITY
YlELD= USED /tALC
COMMENTS:
VALVES. F1T11NGS. HYDRANTS,
MANHOlES AND CATCH BASINS
station Twe I Depth' SIze
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INSPECll0N llME -": 1iJ TO 8; -S 0 ",... '1,,'3() TOTAL HOURS ;L.
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DAILY REPORT
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CUENT ~tt- ~ PROJECT /'/t; ~ 1/.-41 ( DATEJ'zltfj/97 S '(lJw T F S
CONTRACTOR (PRIME/SUB) (2.-,...&::rJ c.. .Hi. SUPERINTENDENT 70..... ~ .
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PAGE OF
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SN-WM-ST-FM
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END STA
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DEPTH x WIDTH
CALC QUANTITY
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COMMENTS:
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JOB NUMBER 102.- () 10. 'I (
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MIlEAGE I S-
TOTAL HOURS
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CONlRACTOR (PRIME/SUB) ~ Y L ~l. L yo .s SUPERINlENDENT ~ c....
TEMP. RANGE ~ '..1' WIND Li- CLOUD COVER PREClPIT A 11 ON -
COMMENTS:
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)AIL Y REPORT
PAGE OF
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CONTRACTOR (PRIME/SUB) ~ ~ SUPERINlENDENT ~ Z;~ --
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END STA
BEGIN ST A
LENGTH
FOREMAN
WORKERS
START TIME
END TIME
MATERIAL
END STA
BEGIN STA
LENGTH
DEPTH x WIDTH
CALC QUANTITY
USED QUANTITY
YlELD= USED kALe
COMMENTS:
VALVES. flT11NGS, HYDRANTS.
MANHOLES AND CATCH BASINS
Station Type Depth Size
COMMENTS:
/:l~ ~ ~ ~ ~
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END STA
BEGIN STA
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FOREMAN
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START TIME
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END STA
BEGIN STA
LENGTH
DEPTH x WIDTH
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, YIELD = USED kALe J
COMMENTS:
VAL VE5. FlT11NGS. HYDRANTS.
MANHOLES AND CATCH BASINS
station Twe Depth SIze
COMMENTS:
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DAILY REPORT
PAGE Of
CUENT {J""O/'l- t..o-I:e PROJECT f,ke L,o./:e /IUM_ DATE IlIn/9~ SlotT W T F(V
CONTRACTOR (PRIME/SUB) ~vfr^J C!orJ{.. SUPERINTENDENT< JIJ~ (2'1kJ
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END STA
BEGIN STA
LENGTH
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COMMENTS:
PLAN SHEET
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SOIL TYPE
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END STA
BEGIN ST A
LENGTH
FOREMAN
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START TIME
END TIME
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VAL VE5, flT11NGS. HYDRANTS.
MANHOLES AND CATCH BASINS
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DAILY REPORT
PAGE OF
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END STA
BEGIN STA
LENGTH
DEPlti x WIDTH
CALC QUANllTY
USED QUANTITY
YlELD= USEO/tAlC
COMMENTS:
PLAN SHEET
STREET
SN-WM-ST-FM
SIZE-MATERIAL
SOIL TYPE
SPEC. GRAN.
END STA
BEGIN ST A
LENGTH
FOREMAN
WORKERS
START TIME
END TIME
VAlVES. rlIIlNGS. HYDRANTS.
MANHOLES AND CATCH BASINS
station T)1)e Depth SIze
COMMENTS: ~~ ~~~. )ff}-~ ~7A-"J ~- /'lfIhJ/,vt:/ ~~~A.J CD.
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INSPECTOR
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DAILY REPORT
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lEMP. RANGE 2 (- L{ 'f
PAGE OF
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END STA
BEGIN ST A
LENGTH
FOREMAN
WORKERS
START TIME
END TIME
MA TERIAL
END STA
BEGIN STA
LENGTH
DEPni x W1DlH
CALC QUANTITY
USED QUANTITY
YlELD= USED kALe
COMMENTS:
VALVES. FlT11NGS, HYDRANlS.
MANHOLES AND CATCH BASINS
Station T)1)e Depth SIze
COWMENlS: r"_ A- LL R. ~ ~ fL- -I-- -J.-
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White - Offlce Yellow - Inspector
TOTAL HOURS
INSPECTOR
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DAILY REPORT
PAGE Of
CUENT P!-/OI'- tJ'e PROJECT f, k~ Ltok-Q. T~ DATE ~/u /t:t~ S M T Wcl)F S
CONTRACTOR (PftIME/.sU~) ~'t j:Jr,J ~v-. / f S Iv'\- SUPERINTENDENT TD~ l<.yt4,v
TEMP. RANGE itJo · - t3CJ tJ WIND S -- ( a CLOUD COVER ~ PREClPIT A 11 ON ~
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CREW , CREW 2
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SN-WM-ST-FM
SIZE-MA TERIAL
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END STA
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START TIME
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END STA
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DEPTH x WIDTH
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COMMENTS:
I
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White - Office
Yellow - Inspector
~ '., "
_ _ ~ ~ ~~ j J CONSULllHG ENGINEERS
~. .., Maier Stewart &. Associates Inc.
DAILY REPORT
PAGE OF
CUENT ftLluf'- L~ PROJECT fIG:, (~~" DATE Blz-~/f13 S M T&i}T F S
CONTRACTOR (PRI!AE/~) ~ ~ ./ L...J h\.. SUPERINTENDENT 7 ~ ~
TEMP. RANGE ft!b -- qtJ WIND c; -I D CLOUD COVER . r ~ PREClPIT A 11 ON ;t/ q-Y\()
..............
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SN-WM-ST-FM
SIZE-MATERIAL
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station T,)1). Depth Slz.
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O.~~ o-~Cf
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_...._......._~_..~. .................-....
__ ~ j, ~~ j J CONSULllNG ENGINEERS
~. .. Maier Stewart & Associates Inc.
DAILY REPORT
PAGE Of'
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CONTRACTOR (PRIME/SUB) !<'1"hJ ~';,f- / h1o~,tq.~~UPERINTENDENT r/ b ~ e7' ~
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COMMENTS:
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station T)1)e Depth Size
COMMENTS: f}~f p~rY"- -J-- ~. ~ """'^- ~
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_MaierStewart&Associateslnc. AIR/MANDREL TEST REPORT
Ie :t. - 0 If).
PROJECT NAME ~,fe lIJ,kR.IJt.ec.,~ DATE.!1/,,/'13 PROJ. NO. 'I()
CONTRACTOR ~~JIr1J~. SUPERINTENDANT IGII1. ,e..,,,.,,,,/
INSPECTOR. Z>. ft. · r:
SEGMENT
SIZE -
MH-MH LENGTH
I .:2 Itl' ~
..2.. .3 Ij " .2 .;0
.~ tI 8'f ~SD
AIR TEST
DATE TillE INITIAL FINAL TEST
OF TEST SECONDS PRESS PRESS RESULT
,1.,./43
'i It; I 't.,J .S" ~ ,,j L/ ,o~ 3..~~& r
PJ I1-J4~ 5 ,., JAJ 4.2 At 4. 2- ~c- P
COMMENTS: ,:1 J.,~ ~ s i,.... S'Q\4tq,r ILl' I,,~
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MANDREL II:ST
DATE TEST
OF TEST RESULT
I,
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~:.' '", '.1. '. .,., .~.. ',' , '. '.. , ":;".,,". ' '. ",.. .. :'. . : ~ ',.' . '~, \ '.". "'_~" . ... .' '.f . "' .....U;.'
,. ..~ .., . .:' .. \~,t., ." . . .... , '" ,~'.. '~"''I'" '<, " '.'.' ' , '" .' '. . . ~ I '. :_ _, ' " ~'., .! " .' . '
I -1.":'. . , ': ; t. ~..;: ',':.: -: ,~- '.: II: ;:-';:; '::. :' ,..'... ,... '. .'. '.:', 'l;";.' .: . : . ":.:: !',,:~. (. . '" '. . . . '. .
,H9-' .,:;' .!):i.,~;~1*'~~,(:, ::' ::<;/; :\~f,~'.;.~....iITv: . :: ::.::; '.':. '/~~ i/j~ ',.:'j '~~t~l~; :ni"'~J . :'t.'~J: ~~.;
: ,', :'::.'u;iLt:",'3,.:;r'.. ,t. ...', .:,...,.~f.:,..,:.i:::,; :~i:'~:.$;~ 1," ~ f.. . ';~'~~,~~.<i~' S;~,'!:~Lu:{~~~: ~ ' ~.' ~il.""~
87 SEEOING MIXTURE" 900
38 SODDINO.I.AWN & BOULEVARD
89 WOOD FIBER BlANKET
40 SILl FENCE
41 HAY BAILS
042 INPLACE DeNSiTY TEST
43 CLASS 6 GRADAnON TEST
~ C~S8PROCTOR~T
45 CLASS 5 DENSITY lEST,INPLACE
48 CONe. CYL. COMP. TEST (SET OF 3)
47 CONO. AIR ENTRArNMENT TEST
48 CONe. SLUMP TEST
4. BlnJMlNOUS EXTRACllON
SO BITUMINOUS GRAOATlON
61 BJroMINOUS AIR voros
62 BituMINOUS CORE DENSflY
T SCHEDULE 1.0 FOREST OAKS -TOTAL
SCHEDULE 2.0 PIKE lAKE TRAIL
1 MOBlUZAnON
2 r PVC SDR 35 (0 - 8' DEEP)
8 ,- PVC SDR 35 (8' . 10' DEEf2)
... 811 PVC $DR 35 (10' -12' DEEP)
. 0- PVC SDR 38 (12' -14' Deep)
e It" PVC SDR 35 (14'-18' DEEP)
7 1011 DIP Cl.-5O
8 BORE 24w CASINO PIPE
. SAN. SEWER M. H. CO. 8' DEEP)
10 MANHOlE EJ\ I rtA DEPTH (> 8' DEEP)
11 OUTSIDE OROP
12 OUTSJt:lE DROP EXlRA DEPTH (> 2' )
13 CONNECT TO EXl8nNG 1Z- STUB
fot TEMP. PRECAsT CONe. BARRIER
16 a.xa.wve
18 r PVC SERVICE PIPE
17 r pvc PLUQ
1. FOUNOA110N MAu:f'C1AL
18 CIJ:ARINQ
20 GRUBBING
21 ClASS 2 AGGREGATE BASE
22 SILT FENCE
23 SEEDING MIXTURE #700
SCHEbULE 2.0 PIKE LAKE TRAIL - TOTAL
TOTAl. AMOUNT THIS PERIOD
TOTAL AMOUNT TO DAlE
lOOS-6.wk4
~,
AC
8Y
Sy
LF
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
fA
0.8
1600
876
320
24
2
1
1
12
2
2
2
2
2
2
2
LS
LF
LF
u:
LF
IF
LF
LF
EA
LF
EA
LF
LS
LF
EA
LF
EA
LF
AC
AC
TN
LF
AC
1
180
90
70
$S
240
128
80
..
24
1
8.76
1
40
1
15
1
200
0.95
0.95
22
300
0.88
1,000.00
2.00
1.50
2.00
4.00
150.00
80.00
70.00
45.00
80.00
35.-00
35.00
80.00
eo.oo
80.00
200.00
1.000.00
20.00
20.00
20.00
20.00
20.00
3S.00
120.00
1,600.00
70.00
1.&00.00
100.00
2.000.00
20.00
300.00
30.00
60,00
2.00
8.500.00
8,500.00
10.00
2.00
f.Ooo.OO
~
CITY PROJECT NO.: 83-1:
0 0.00 0.' 300.00
0 0.00 600 1.000.00
0 0.00 690 '.035.00
0 0.00 40 80.00
0 0.00 4 18.00
0 0.00 a 1.200.00
0 0.00 t 80.00
0 0.00 1 70.00
0 0.00 . 135.00
0 0.00 1 80.00
0 0.00 1 36.00
0 0.00 1 85.00
0 0.00 a 180.00
0 0.00 2 120.00
0 0.00 2 180.00
(O.73J.. (145.43} 1.27 854.5t.
(145.43) 128.630.80
0 0.00 t 3,000.00
0 0.00 140 2.800.00
0 0.00 55 1.100.00
0 0.00 98 1,800.00
0 0.00 al ',300.00
0 0.00 168 3.100.00
0 0.00 182 6.870.00
0 0.00 80 0.800.00
0 0.00 .. 8.000.00
0 0.00 24.88 1.708.60
0 0.00 t 1.500.00
0 0.00 8.71 875.Go
0 0.00 1 2.000.00
0 0.00 40 800.00
0 0.00 1 300.00
0 0.00 U 330.00
0 0.00 t 60.00
0 0.00 200 400.00
0 0.00 0.$7 1.995.00
0 0.00 0.42 1.470.00
0 0.00 16$.41 1,684.10
0 0.00 S78 752.00
0 0.00 0.88 _ 880.00
0.00 48,492.70
(145.43)
177,423.30
llSI.
l1N8ULmG lima
CML ENGINEEIING-
ENVIRONMENTAL
}/;UNlCIPAL
PlANNING
ST~UCTUItAL
SUtVEYING
TRAffiC
TRANSPORT A TION
J 326 Energy Park Drive
St. Paul, MN 55108
612-644-4389
Fax: 612-644-9446
9800 Shelard Parkway
p.
~
'/)"t9/ At (
ot~ ~J(- ~\f 0" ~
[0'. \ ' rP if (J,~'';..
_ lOrJ PUNCH liST
r" ' JU (.I:' .iNAL)
~ ~ PIKE LAKE TRAIL
t PRIOR LAKE, MINNESOTA
(102-010-41)
( / DECEMBER 27, 1993
~ I P eo k Co -'vO tv. :r:",; <J:Vv f +- fA kL.. {L I t-iP evf
,,y Repair bottom Step in manhole #1. ~ M '6 ~ 01 t.r
.if
Mark the 2 manholes in green area per plan.
3. Turn in televising tape to MSA or Prior Lake Engineering Department ~~
(~t\-..c. 0 ,e - flit ItJDJC- W IK A ()'~t-~ O"?\.. ~
SAN
MH-S ./
Se.r-J,u.. - ~#t,v c kj
Lk....-.ck h A- ~ fro ~ wI wc>5/0 N
d" w~h ~ ~ -)/~
(,~~ ,^~rtJ~ wi '-LA-s5S- wl1sLJ~
ok> /k9. · 0t1 P, t.e W.J. +r(A.' L. ~ ::J:;;.rk
), .....c.,..... ...ylo,~ (DDl.t' if ..(- BriAc.e. L) 40 w->
~o tl\;f' -k,~
Minn~. r .~" MN 55441 b:(cIsb)102OIO.Ge
612-546-0A32
Fox: 612.544-6398
Please contact Dave Thompson (pager 621-0738 or O~fice 644-4389) if you have questions.
--
"'-"
'-
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toNSIIt'lUG IIClNB18
PUNCH LIST
t~ u\fAL)
PIKE LAKE TRAIL
PRIOR LAKE, MINNESOTA
(102-010-41)
DECEMBER 27, 1993
CIVIL ENGINEEtING:
ENVIRONMENTAl
~rJe-
~ Repair bottom step in manhole #1.
MUNICIPAL
2.
~~
Mark the 2 manholes in green area per plan. _;1\ tJo f'/\~~
PLANNING
~ Turn in televising tape to MSA or Prior Lake Engineering Department.
f).:>i\J f. /
oA;,
SrRUCTUtAl
SURVEYING
TRAFFIC
TRANSPORTATION
1326 Energy Park OrNe
St. Paul, MN 55108
612-644.~89
Fax: 612.~.94A6
9800 Shelard Parftway
Minneapolis, MN S5..Ul
612.5A6.0432
fax: 612.5.<<.6398
It:(clJb)l OJ lO.JjI
Plf"ASe contact Dave Thompson (pager 621-0738 or Office 644-4389) if you have questions.
:...J
ltllER OF TRANSMlnAl
, ~..........,.
11 Sll
TO: n1 A f< Ie
c ,...,~ ,1!/lt.ll'l {Ale
~Y1 t1 . i) .[1 r:;-} .
,
o)ISEL'ft~G ENGINEERS
135 Eneru Part lrife · St Pul, B~ ~1O~ . "'ParkI'lf,8I8.1I'IIiIr.If6,BI it.u-6i~
IIt.ltHUt. Fat IIt.IU-tHI 6~4t..,"~. Far. 11~.~f.
WE ARE SENDING YOU )(Attached D Under separate cover via
D Shop drawings 0 Prints
o Copy of letter 0 Chanle order
COPIES DATE NO.
~ I '//, ., II Pq t=/ {/.t; fa tl .,.
I 'I / c,- , I , .
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THESE ARE TRANSMITTED as checked below:
'-.1
DATE: Y / r /9 y PROJEG NO. P I' Il:~ ft (PI lQ..
amNTlOH: rl,) A /l ):.
RE: ..s ~ LJ P It- T A /.R 5 ~ ~.P'ott. f~
the following items:
o Plans 0 Samples 0 Speeifi~tions
~ S,+u. ~"w(l It... i.A ptJ.5 ~ t'l1.l'eJ/l.!S
DESCRIPTION
f'Kf leYe I~AI(, !~2 .. 010. '10
UOcJi) ~ I06f E. sl ;)rJ(J 101.. ~ Of I . I.f/
WfS../ t?d4l2.. F $+. 1<) 2. ... 0)1. '"' I
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J.J (J Sa I /, f.Afl '"I ~ III /J '-> I S f
,
,10~ ..()o8. Yo
dl'lQ Jr72... () II... J.fl
10'.2 . 0 I g. Y I
I~ L' 0 I Y . f./I
o For approval
-. For your use
o As requested
o Approved as submitted
o Approved IS noted
o Returned for corrections
o Resubmit.
o Submit
o Return
copies for approval
copies for distribution
corrected prints
o For review and comment 0
o FOR BIDS DUE 19 0 PRINTS RETURNED Ar 1l:.R LOAN TO US
REMARKS ~ t2. 'A ( ..tl uJ A ~ ~ I t) e ^I 't lJ1. -.t.'Ar D.Q 14. rV lJ ~ Polt "I-
-CoR WA-t:o~Ft2.0N~ PASSAt;2 BlA~)'/VPSS h-1?,I::... IOl-Q/~.~
.D~ I\J G /,If ~ n -I J.,,,,1t Lt.I / / I
Of 1 A.p.Jl A ~ n f& f' () rt.. +-
j. ,.j c,~t4 (. ( ..p 0 . Q IV {' 0..... VI ..j ~
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LA -I., , , -I ,~.e. S fA (J fil.A ~ Iv :2
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S PJ'IJ D Bl'u (. ~ ;4 f! t:Jt~/
(0. tl.._ S" ~ rJ. ') ..ti wee.
R 0 A f) LI ~ A ;v I,)
No fL'/ '" fI.p ~ rJ.p n -I, A L.
- n 16. ~ /. '-/ A. ( ~
() ,J :( /~q I C) ~/.
SIGNED: Sn f. l_l'lyyC. -- -__
" endotUN' .,. ftOt a. notH. 'dndl~ ..atIlt UI al once.
COpy TO
-'
!111"\l.5 ".--:;~ L":'"? l": ~~;. .
.. .- . .
~ r<\ SI:Y I 6 1993 ~ \ ~.;
1\ '\\ v)t
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! ~itl( ~t~.i,.Jtf & ':J-.,l".. .".. j ~ ~
I. ."
...:.:
,'''''-;-
r
racting Inc.
/"
September 14, 1993
REI PIKE LAKE TRAIL SANIT~RV SEWER EXTENSION
Prio~ Lake, Minnesota
,
\v(y kL
vJ ,5 ~~l.
V ~.t-
~ ~ \.,.~
~y
Maier Stewart & Associates
Attentionl Tom Roushar, P.E.
1959 Sloan Plaee
Suite #200
St. Paul, Minnesota 55117
DeaY" TOil:
~-'/
i~v,~v-j;
..-
,
1Lf( .uO
~? 09/01/93 - W.O.lt66971 Ruove and reinstall 12" CMP from ~
entrance road to church. Also, lower manhole # 3 one foot.:S ,.00
EO'Jioment, 1: tJt- S~ c:>>
400 Hi taeQ R..~e, 2.:> hl"s qo $90. 00/hrooJ. ! '1.,{..fe $225. ~~ 2...1S". ~
D-5 Dozel"', 2 hrs /t08. 00/hr. . . . . . . . . . . . . .. . S;;11. . . . t N...6.110
~JTotal Equipment........ ........3~0
c
~ LaboY" 6 7... ~
~ ~ ( FOY"eman wI truck, 1.~ hrs @ $45.00lhr~......... 67.30 ~ ~~
~ 3 Operators, 1.5 h~s ea & $40.0~/hr.~...!~~:..~.lae.ea ~~,~~
~ . .) Laborers, 1.5 hr. ea @ $38. 00/hr. . . . . . ... . . . $114. 00 llf.t~ ~
L- Total Labor...... ............. $361. 50 ~ _ ~
~l)I.S"O ~~ ~ ~.
TOTAL AMOUNT........................ ~...... .....$~0 ~,.SO.
After you have had a chance to review this request ~ ~.
please call if you have Any questions or if you would like
to discuss anything. Otherwise, we would greatly appreciate
l your payment for the a.aunt requested as soon as possible or
~dded to our ne~t pay application.
Thank yo ~i'J. '7 O-{)tJ J AJ.J c(J
ted, 5 '/9 . ~ ~ - CI"l'\ '-7
~~~l (J'N. ~~. rl$ n
t"'~fC- ~ ~ ~,-
10\) C) ~ (,. I t7fJ~"
An equal opportunity employer
~C1osure /
1534 E. Cliff Road. BumsvllIe, MN 55337 · 612..894-3200 · Fax: 612-894...3207
Please accept this as our request for payment on extra
time and material work performed at the above referenced
project. It is as fo110w51
'-
7;"A, /
wall'
Work Order N~
Oate ?-/.?? Job. No. ?_,,~
,engineer /'I;f#~~ ~~
(Check One)
EXTRA WORK X TIME and MAlERIAL WORK
.6897
AY AN CONTRACTING, INC. Job Name
1534 E. CLIFF ROAD '
BURNSVILLE, MN 55337 Location .
81200894-3200 · 612a8604658
FAX 612-894-3207
A"t/
/A~/
/- ..
. ,.. ". ~r,
.LA/..~r
Job Conditions (Weather. etc.).
.
SpeclflcaJly Describe Work .
Pfan Sh,et No.CI)
/ R~A;f
A";- ......, r,~..r .A .4.;/.1
~ /. .
~ ~ ......
~/ ,1A/("7;4// /..:J '*" (A,/~
;(...: ~J -:-> / /';
RSBson For Work- .tr'Omll.lon From Plans & Specs
Check One(l)
o Other - Describe _
~. \JUIPMENT/NOS.
Backhoe(s) 4lu 111-1/10/,'
Loader(s)
Oozer( s) ()-~
Serapere s)
Compactors
Blade
Low Boy
Paver
Dump Ttuck(s)
Boom Truck
...."
. t ~b eat
Water Truck
Comments.. Sketches
r ..(.' .T r"'<,"~ Nr F' "kbAd
,7;1 r .,(/~"A"~.#
C Change In Design C Different Site Conditions C Owners Request
HOURS
LABOR/NAME
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