HomeMy WebLinkAboutCOR_TSI #2 Crosswalk PedestalPE
Appr'l
Code
Date
Project Engineer Distribution State Materials Engineer Distrubution
Contractor General File Signing Inpsection
Region Operations Engineer Other __________________________________
Fabrication Inspection M/S 47365
Revised 03/2018
Region Materials
State Materials Lab
DOT Form 350-071
10. Approval Withheld:
11. Miscellaneous Acceptance Criteria.
Remarks:
5. Acceptance Criteria: Only 'Approved for Shipment' or 'WSDOT Inspected' or 'Fabrication Approved Decal' material shall be used.
6. Acceptance Criteria: Submit Materials Certificate of Origin to Project Engineer.
7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action.
8. Source Approved:
______________________________________________________________________________________
9. Approval Withheld: Submit samples for preliminary evaluation.
Approval Action Codes for use by Project Engineer and state Materials Laboratory
1. Acceptance Criteria: Acceptance based upon 'Satisfactory' Test Report for samples of materials to be incorporated into project.
2. Acceptance Criteria: Submit Mfg. Cert of Compliance for 'Acceptance' prior to use of material
3. Acceptance Criteria: Catalog Cuts for 'Acceptance' prior to use of material. Catalog Cut Approved Yes No
4. Acceptance Criteria: Submit Shop Drawings for 'Approval' prior to fabrication of mateiral.
Project Engineer/Representative Date State Materials Engineer
1 Crosswalk Pedestal - Push Button Post Frey Manufacturing - Seattle WA 9-29
This shall be completed prior to submittal. If this form is not complete at time of submittal it may be returned for
information that was omitted.
For WSDOT Use Only
RAM #
Bid Item
No.
Material or
Manufacturer's Product/Type
Name and Location of Fabricator,
Manufacturer or Pit Number
Specification
Reference
Hdqtr.
Appr'l
Code
Hazen High School Pedestrian SignalsContractor Subcontractor
Sare Electric Transportation Systems Inc TSI#2
2/18/2026
Section / Title of Project County
Request for Approval of Material
Contract Number FA Number SR Date
Washington State
Department of Transportation