5370-1 Construction Progress and Inspection Report

OMB Control Number 2012-0569
Exp. Date 11/30/2013

Period Ending

CONSTRUCTION PROGRESS AND
INSPECTION REPORT
AIRPORT GRANT PROGRAM

U.S. Department
of Transportation
Federal Aviation
Administration

Project Number

Airport Name
Project Description

Contractor's Name

1. Rough Estimate of Percent Completion to Date of Construction Phases (include Items such as clearing, grading, drainage, base, surface, lighting, etc.)

2. Work Completed or in Progress this period

3. Brief Weather Summary This Period Including Approximate Rainfall and Periods of Below Freezing Temperature
(On earthwork jobs include soil conditions)

4. Contract Time

No Days
Charged To
Date

5. Summary of Laboratory and Field Testing This Period (Note failing tests and any retests. Summarize
out-of-tolerance.)

Last Working
Day Charged
(Date)

Material. (Identify material subject to pay reduction.)

6. Describe Anticipated Work by Contractor for Next Period

7. Problem Areas/Other Comments (Revisions to plans and specifications approved or denied, delays, difficulties, etc. and actions taken.)

Date

SPONSOR'S INSPECTOR OR REPRESENTATIVE
Typed or Printed Name and Title
Signature

FAA Form 5370-1 (8-89) Supersedes Previous Edition

INSTRUCTIONS FOR PREPARATION OF FAA FORM 5370-1 (8-89)

CONSTRUCTION PROGRESS AND INSPECTION REPORT
AIRPORT GRANT PROGRAM

This preaddressed form is to be filled out, with ballpoint pen or typewriter by the Sponsors Inspector on the project,
folded with return address out, fastened, and mailed to the address shown below. No postage Is required since the
postage has been prepaid by the Federal Aviation Administration.
Submit one copy for each report. If additional space Is required to complete any of the items, continue on a separate
sheet of plain paper, identifying it with the project number, fold and insert inside the report before mailing.
If additional blank copies of the form are required, submit your request to the address provided below.

U.S. GPO:1989-261-335/03364

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TAPE HERE

Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be
subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection
of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for
this collection of information is estimated to be approximately 30 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses are required to retain a
benefit under 49 CFR 18. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, AES-200.

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U.S. Department
of Transportation
Federal Aviation
Administration

800 Independence Avenue, S.W.
Washington, D.C. 20591

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED
STATES

BUSINESS REPLY MAIL
FIRST CLASS

PERMIT NO. 12438

WASHINGTON D.C.

POSTAGE WILL BE PAID BY THE FEDERAL AVIATION ADMINISTRATION
Official Business
Penalty for Private Use $200

Federal Aviation Administration
Airports District Office
12 New England Executive Park
Anchorage, AK 99513