HomeMy WebLinkAboutTCS - 2/14/2017 � Wash7ngtcn state Contractor's Daily Report of
�I/ Department of Transportation Traffic Control - Summary
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"03853 709.3-TCS 02/14/2017'
Page One
Cc tr ct Number SR Number Da Date
Cc
1/ 5E� i sL1
Photos /Videos taken today for record? ❑Yes No
If Yes, note locations: / \
Summary of T-CS Activities
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Contr r Contra to ' Traffi ontrol Su rvisor' Signature
Comments
To be Completed by Contractor's Traffic Control Supervisor(TCS)
DOT Form 421-040A EF Distribution: White-Contractor;Canary-Project Engineer
Revised 4/2004
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Washkwton State Contractor's Daily Report of Traffic
A Department of Twanwortation Control - Traffic Control Log
Use separate sheets for each setup. (May be altered to record Class A signs.) Page
Con act Number SR Number
� Da Dat �
Sta A Setup 4 Sta B Legend
Station - Time Station - Time (List of Signs Used)
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1C�Y_ - F� _ stS�- i,titS� Oz i�j S
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- 1l <S> O 4--1 tCcs
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4 . N I> O �-
P�
jnr(- Cones Piloted
Ifo n - O Ye ❑No ❑ Yes `f
Per Approved Plan Plan Title
JZY-es ❑No
TSta C .One Way Traffic Flagger/Spotter Sta Start End Hours(one or more lanes) Sta ® Station A
Two WayTraffic Station B
(two or more lanes) Station C
Station D
Other Traffic Control Labor
Name Start I End Hours
�� Contra forr
C nt c Tra is Control Supervisor's Signature
Type of Traffic Control Time Set Up Time(s)Checked Time Removed
0
2`I'3
To be Completed by Contractor's Traffic Control Supervisor(TCS) � ✓t/
DOT Form 421-0408 EF Distribution: White-Contractor;Canary-Project Engineer
Revised 03/2008