Loading...
HomeMy WebLinkAbout26 00 00-5-2 - Signal Poles and Bolts_SKANSKA REVIEWED (003) Request for Approval of Material Contract Number 221110 FA Number SR Date Section / Title of Pr Traffic Signal-Lind Ave SW and SW 19th Street County King Contractor Ceccanti Subcontractor West Coast Signal This form 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 assistance in completing, see Instructions and Example Project Engineer Distribution State Materials Engineer Distribution Contractor Region Materials General File Signing Inspection Region Operations Engineer Fabrication Inspection DOT Form 350-071 EF Revised 12/2012 State Materials Lab M/S 47365 Other For WSDOT Use Only RAM # Bid Item No. Material or Product/Type Name and Location of Fabricator, Manufacturer or Pit Number Specification Reference PE/QPL Code Hdqtr./QPL Code 3A Traffic Signal Mast Arm Ameron – Tulsa, OK 9-29.6(1) Project Engineer Date State Materials Engineer Date Acceptance 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: 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 material. 5. Acceptance Criteria: Only 'Approved for Shipment', 'WSDOT Inspected' or 'Fabrication Approved Decal' material shall be used. 6. Acceptance Criteria: Submit Certificate of Materials Origin to Project Engineer Office. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action. 8. Source Approved: 9. Approval Withheld: Submit samples for preliminary evaluation. 10. Approval Withheld: 11. Miscellaneous Acceptance Criteria. Remarks: Type text here04/0304/03/23 04/03/23 04/03/23 04/03/23 04