Scribd
Upload
178 views1 page

Form Approval Material

This document is a request for approval of materials to be used on a construction project. It provides key details about the project including the contract and FA numbers, section/title, county, and contractor. It lists the bid items, materials/products, name and location of manufacturers, and specification references. Space is provided for the project engineer and state materials engineer to review and note the acceptance criteria and approval/withholding of each material based on test reports, certifications, catalog cuts, or other requirements. Remarks can also be included. Upon completion, copies are distributed to the contractor, region staff, state lab, and other parties.

Uploaded by

Dwipras Tyo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
178 views1 page

Form Approval Material

This document is a request for approval of materials to be used on a construction project. It provides key details about the project including the contract and FA numbers, section/title, county, and contractor. It lists the bid items, materials/products, name and location of manufacturers, and specification references. Space is provided for the project engineer and state materials engineer to review and note the acceptance criteria and approval/withholding of each material based on test reports, certifications, catalog cuts, or other requirements. Remarks can also be included. Upon completion, copies are distributed to the contractor, region staff, state lab, and other parties.

Uploaded by

Dwipras Tyo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Request for Approval of Material

Contract Number FA Number SR Date

Section / Title of Project County

Contractor Subcontractor

This form shall be completed prior to submittal. If this form is not compete at time of submittal it may be For WSDOT Use Only
returned for information that was omitted. RAM #
Bid Item Material or Product/ Name and Location of Fabricator, Specification Reference PE/QPL Code Hdqtr./QPL Code
No. Type Manufacturer or Pit Number

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:

Project Engineer Distribution State Materials Engineer Distribution


Contractor Region Materials General File Signing Inspection
Region Operations Engineer State Materials Lab Other
Fabrication Inspection   
MS 47365
DOT Form 350-071
Revised 03/2018

You might also like