Information Required for Deflection Studies

Deflection Study Request Form (DOC 142K)

Please send all requests to District 01 Materials Lab

Questions: Call (707) 445-6355

Information needed on form:

Date Needed:

Project Contact Person:

EA: Phone No.:

District:

Maintenance Yard Area Superintendent Phone No.

DME: Phone No.

District Traffic Control Contact Person: Fax No.: Phone No.:

County: Route:

Postmile Limits:

Project Phase: PSSR PSR PR PS&E Date of:______ PSSR PSR PR PS&E Date of:______

Project Type: CAPM DETOUR REHAB SPECIAL SUPPLEMENTAL

Project Description: Mainline Shoulders Other Mainline Shoulders Other ______________
(convert to traveled way) (specify)

Ramps (include listing of ramps)
Structural Section: Are Cores Needed? Yes No

Are as-builts available?* Yes No

Are there previous reports? Yes No

For multiple type pavements, specify post miles:

AC From_______ To_______

PCC** From_______

To_______

AC/PCC From_______ To_______, Is PCC cracked & seated? Yes No Yes No

For rigid pavements, list lane number(s) to considered for rehabilitation_____________________

Traffic Index: Mainline Outside Lane(s) _______
Inside Lane(s) _______
Ramps ___________ Design life in years:_______
(For ramps with different TI, include listing)

Remarks: