Elastomeric Bridge Bearing Pads Worksheet DMS-7365

Manufacturer Information
Project Information

Step 1 of 2

Manufacturer Information

Manufacturer's Name and Location:

Manufacturer's Job Number:

Invoice #:

Step 2 of 2

Project Information

Control Number (CCSJ):

Other Entity Name (if applicable):

County:

Project Number:

Specification¹	Material Code	Size	Quantity	Testing Lot #

¹Please select a standard specification or special specification, and the material code from the drop-down menus. Input bearing size, quantity, and testing lot # for each line item. "Other" should be selected when bearings are not covered under any of the spec items listed.

Certification

1. Materials, special components, dimensions, appearance, repairs (if applicable), and required inspections were verified and meet Department specifications.

QC Tech Signature:

Date:

2. Certified finished products conform to all specification requirements.

QC Tech Signature:

Date:

Additional comments: (Bearing Mfg. to add comments when "other" is selected in the specification drop-down list.)

For TxDOT use only

Lab / Sample #

Producer Code: