SOURCE APPROVAL OF COARSE AGGREGATE

FOR PCC, CRUSHED STONE

PART I:  (PRODUCER REQUEST)

Producer:      Source Name: 

Location:    Sec    Twp   Rng    County: 

Durability Class Requested:       Bed Nos.: 

By:       Date: 

PART II:  (DISTRICT RECOMMENDATIONS)

By:       Date: 

PART III:  (CENTRAL OFFICE DETERMINATION)

Preliminary Approval:      Date: 

Final Approval:        Date: 

Beds:      Durability Class:      T203 Code No.:

DATA SHEET

(QUARRIES)

1.   LEDGE TESTS:

Lab #              'A'              Abr              SpGr            Abs             PI               DF                 Bed #

2.   PRODUCTION TESTS:

Lab #              'A'              Abr              SpGr            Abs             PI               DF            Remarks

3.   SERVICE RECORD:

Project Number                   Year                  County               Rte              MP            Condition

4.   SIMILAR SOURCES:

5.   OTHER TESTS: