****THIS IS A NEW APPENDIX. PLEASE READ CAREFULLY.****

 

IOWA DEPARTMENT OF TRANSPORTATION

HIGHWAY DIVISION MATERIALS

 

FABRICATION INSPECTION SHIPMENT RELEASE

 

 

FABRICATOR:________________________________________________________________

 

PROJECT NUMBER:_________________________________COUNTY:_________________

 

DESIGN NUMBER:____________________________________________________________

 

 

Fabricator Job Number

Item Description / Remarks

Quantity

 

 

 

The material items described above is released for use subject to dimensional conformance, material grade, fit of connections, and acceptance at the project site when the Iowa DOT stamp has been affixed to this document.

Iowa DOT Stamp

 

 

 

 

 

 

_____________________________

Inspector Signature

 

Date