PDB Dam Foundation Preparation Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• What station is being inspected?

Inspection

• Is the surface clear of all blast rock remnants

  Yes

  No

  N/A

• PKI sign off

  Sign

• MH sign off

  Sign

• Is the surface thoroughly cleaned of all soil, ice, snow, and other deleterious material?

  Yes

  No

  N/A

• PKI sign off

  Sign

• MH sign off

  Sign

• Are all joints, cavities, faults and potholes excavated and thoroughly cleaned

  Yes

  No

  N/A

• PKI sign off

  Sign

• MH sign off

  Sign

• Surfaces requiring dental concrete have been washed with 15,000psi washer.<br><br>Survey is to map all areas designated for dental concrete prior to placement of concrete.

  Yes

  No

  N/A

• PKI sign off

  Sign

• MH sign off

  Sign

• Holes and depressions filled with concrete or slush grout as directed by the Engineer<br><br>A copy of the completed dental concrete checklist has been verified.

  Yes

  No

  N/A

• PKI sign off

  Sign

• MH sign off

  Sign

• Final cleaning of surface is complete as per specifications for each zone (class 1, downstream class 3/4, upstream class 3/4, and class 5,6,7,8)

  Yes

  No

  N/A

• PKI sign off

  Sign

• MH sign off

  Sign

• Surface has been as built by PKI survey<br><br>Survey drawing showing area being signed off and all areas dental concreted outlined

  Yes

  No

  N/A

• PKI sign off

  Sign

• MH sign off

  Sign

Final sign off

• Field Engineer

  Sign

• Superintendent

  Sign

• Quality

  Sign

• Owner rep

  Sign