Single Form – Southeast Culvert

- Pipe Type*
  - Straight
  - Single Wall
  - Bell & Spigot
- Diameter*
  - 12"
  - 15"
  - 18"
  - 24"
  - 30"
  - 36"
  - 48"
- Diameter*
  - 12"
  - 15"
  - 18"
  - 24"
- Diameter*
  - 12"
  - 15"
  - 18"
  - 24"
  - 30"
  - 36"
  - 42"
  - 48"
  - 60"
- Length*
  - 20
- Length*
  - 24
  - 30
- Operator*
- Person conducting check*
- Team*
  - A
  - B
  - C
  - D
- Line*
  - 20A
  - 20B
  - 40
  - 60
- Shift*
  - Day
  - Night
- Device used for measurement*
  - Micrometer Red
  - Micrometer Black
  - Micrometer Blue
  - Micrometer Green
  - Micrometer Orange
  - Micrometer Yellow
  - Micrometer White
  - Ultrasonic Gauge
- Was Ultrasonic Gauge verified against destructive (micrometer) sample in 8 locations before use?*
  - Yes
  - No
- Production Date*
  Date Format: MM slash DD slash YYYY
- I.D.*
- Time*
  
  : HH
  
  MM
- 0.0250” Gauge Block Measurement*
  Please enter a number from 0.0240 to 0.0260.
  (Verify within 0.001 of Gauge Block prior to use)
- 0.2000” Gauge Block Measurement*
  Please enter a number from 0.1990 to 0.2010.
  (Verify within 0.001 of Gauge Block prior to use)
- 0.5000” Gauge Block Measurement*
  Please enter a number from 0.4990 to 0.5010.
  (Verify within 0.001 of Gauge Block prior to use)
- Length #1*
  Please enter a number greater than or equal to 0.1.
- Pipe Wt #1*
  Please enter a number greater than or equal to 0.1.
- Wt/Ft #1*
- Length #2*
  Please enter a number greater than or equal to 0.1.
- Pipe Wt #2*
  Please enter a number greater than or equal to 0.1.
- Wt/Ft #2*
- Mic Picture

Save and Continue Later

- Workmanship*
  - Excellent
  - Good
  - OK
  - Poor
- Markings*
  - Excellent
  - Good
  - OK
  - Poor

Targets for 12" pipe:
Outer	.06 - .052
Inner	.06 - .050
Comp	.11 - .08
Bell Target	.14
Weight/ft.	Array
Pipe Weight	66

Targets for 15" pipe:
Outer	.07 - .061
Inner	.07 - .060
Comp	.14 - .11
Bell Target	.17
Weight/ft.	Array
Pipe Weight	100

Targets for 18" pipe:
Outer	.08 - .069
Inner	.08 - .071
Comp	.16 - .13
Bell Target	.18
Weight/ft.	Array
Pipe Weight	132

Targets for 24" pipe:
Outer	.10 - .087
Inner	.11 - .085
Comp	.20 - .16
Bell Target	.27
Weight/ft.	Array
Pipe Weight	230

Targets for 30" pipe:
Outer	.12 - .100
Inner	.12 - .100
Comp	.23 - .200
Bell Target	.31
Weight/ft.	Array
Pipe Weight	328

Targets for 36" pipe:
Outer	.14 - .120
Inner	.15 - .120
Comp	.27 - .230
Bell Target	.31
Weight/ft.	Array
Pipe Weight	442

Targets for 42" pipe:
Outer	.16 - .131
Inner	.13 - .110
Comp	.28 - .240
Bell Target	.31
Weight/ft.	Array
Pipe Weight	560

Targets for 48" pipe:
Outer	.17 - .135
Inner	.16 - .130
Comp	.31 - .270
Bell Target	.31
Weight/ft.	Array
Pipe Weight	710

Targets for 60" pipe:
Outer	.24 - .215
Inner	.24 - .210
Comp	.46 - .410
Bell Target	.38
Weight/ft.	Array
Pipe Weight	1180

- Innerwall Thickness
- Outerwall Thickness
- Top Vacuum*
- Top*
- Top Operator*
- Top Vacuum*
- Top*
- Top Operator*
- Vacuum*
- Average*
- Operator*
- Vacuum*
- Average*
- Operator*
- Bottom Vacuum*
- Bottom*
- Bottom Operator*
- Bottom Vacuum*
- Bottom*
- Bottom Operator*
- Range %*
- Range %*
- Is any outer wall thickness visibly thinner than what is recorded?*
  - Yes
  - No
  If yes, ensure that the thickness is greater than 60% of the design target

Save and Continue Later

- Compression
- Bell Measurements
- Top*
- Top*
- Vacuum*
- Average*
- Operator*
- Vacuum*
- Average*
- Operator*
- Bottom*
- Bottom*
- Is the flow in the bell uniform?*
  - Yes
  - No
- Is there any roll up in the spigot?*
  - Yes
  - No

Save and Continue Later

- Comments

Save and Continue Later

Mic Sheet

Innerwall Thickness

Outerwall Thickness

Compression

Bell Measurements