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Federal Highway Administration Research and Technology
Coordinating, Developing, and Delivering Highway Transportation Innovations

Report
This report is an archived publication and may contain dated technical, contact, and link information
Publication Number: FHWA-HRT-06-068
Date: March 2006

Long-Term Pavement Performance Maintenance and Rehabilitation Data Collection Guide

Chapter 2. Status Change Request

A specific set of forms is required for any maintenance or rehabilitation activity on a test section. First, when a highway agency notifies the LTPP program that rehabilitation of a test section is planned or rehabilitates a test section without previous notification, the RSC must coordinate with the agency to complete Rehabilitation Information Form RI-1, (Cause for Rehabilitation), in accordance with LTPP guidelines.

If the proposed rehabilitation treatment conforms to current LTPP policy on monitoring continuation of rehabilitated test sections and the highway agency is willing to support continued monitoring, the responsible RSC must coordinate with the highway agency to complete Rehabilitation Information Form RI-2 (Monitoring Continuation Request) and have it signed by the appropriate highway agency official.

Regardless of what sort of activity takes place and whether or not the section will continue to be monitored, a Test Section Status Change Request (IMS Form 1) must be completed and submitted by the RSC.

This chapter provides directions for completing these forms.

2.1 IMS FORM 1, TEST SECTION STATUS CHANGE REQUEST

The information provided here is based on LTPP Program Directive I-84 (Directive I-84) and concerns the changes associated with rehabilitation of a test section. Additional information about this form and its uses can be found in the directive.

Requests for changes to information contained in the EXPERIMENT_SECTION table in the LTPP Information Management System (IMS) must be made using the IMS Form 1. Completed copies of this form along with supporting information must be submitted to the Federal Highway Administration (FHWA) LTPP team, with a copy to the LTPP Technical Support Services Contractor (TSSC). IMS Form 1 submissions must be signed or submitted by either the Regional Database Manager or the Regional Program Manager.

2.1.1 Data Elements

Data elements contained on the IMS Form 1 include:

State Code: State code is the number used to identify the State or the Canadian Province in which the pavement section is located. The codes presented in appendix A, table A.1 are to be used.

SHRP ID: SHRP ID is the four-digit identification number assigned to the test section by the LTPP program. This number is used to facilitate database referencing and field identification.

Date: This is the date the form was submitted.

Region (Item 1): The numeric code used to identify the region submitting the form. The region code assignments are:

North Central Region 1
North Atlantic Region 2
Southern Region 3
Western Region 4

New Record to be Added to Experiment Section (Item 2): Typically, new records are added to the EXPERIMENT_SECTION table due to a change in CONSTRUCTION_NO caused by a maintenance or rehabilitation event. This part of the form is used for the addition of a record with a new construction number for an existing test section, whether or not the experiment type has changed. The fields included in this section are:

CONSTRUCTION_NO: Event number used to relate changes in pavement structure with other time dependent data elements. This field is set to 1 when a test section is initially accepted into LTPP and is incremented with each construction related change to the pavement.

CN_ASSIGN_DATE: The assignment date for the beginning of a construction event. It is equal to the acceptance date when a test section is first accepted into the LTPP program, e.g., CONSTRUCTION_NO = 1. It corresponds to the construction activity start date when the pavement layer structure is modified by maintenance or rehabilitation. CN_ASSIGN_DATE is used by the IMS software to assign construction numbers (CN) to records contained in other tables. When a construction event occurs that causes an increment in CONSTRUCTION_NO, CN_ASSIGN_DATE (CN) must be less than or occur before CN_ASSIGN_DATE (CN+1).

CN_CHANGE_REASON: Code indicating the reason(s) for changing CONSTRUCTION_NO. A numeric code is assigned to the CN_CHANGE_REASON to indicate the type of maintenance or rehabilitation a test section received. Multiple codes may be assigned to indicate various maintenance/rehabilitation treatments a test section received. When multiple codes are entered, they should be separated with commas. Leading zeroes for single digit codes shall not be used. The codes can be found in appendix A, table A.16.

GPS_SPS: Code indicating if the section is either assigned to the GPS (G) or SPS (S).

EXPERIMENT_NO: Indicates which LTPP experiment the pavement section is assigned to. This two-digit code consists of a number followed by an optional suffix letter. The suffix is used for some experiments to indicate a subcategory of test sections.

ASSIGN_DATE: Date when a test section was assigned to the LTPP experiment. The LTPP experiment for a test section is the combination of EXPERIMENT_NO and GPS_SPS fields in the record. When a section is first accepted into LTPP, ASSIGN_DATE is the acceptance date. ASSIGN_DATE is the construction start date and should equal the CN_ASSIGN_DATE, e.g., ASSIGN_DATE (CN+1) = CN_ASSIGN_DATE (CN+1) if EXPERIMENT_NO (CN) ? EXPERIMENT_NO (CN+1).

SEAS_ID: State-specific Seasonal Monitoring Program (SMP) identification code indicating that SMP measurements were made for the corresponding construction number. SEAS_ID is set to A for the first SMP site installed in a State, B for the second site, etc. This field shall only be populated for construction numbers in which SMP data were collected. When a construction event occurs on a SMP test section that results in termination of its participation in the SMP, or if SMP monitoring was previously terminated before a new construction event occurs, SEAS_ID shall be set to null in the EXPERIMENT_SECTION record corresponding to the new CN for which no SMP data are available.

SUPPLEMENTAL: This field is set to "S" if the test section is a highway agency supplemental section on SPS project sites.

Changes to Existing EXPERIMENT_SECTION Record(s) (Item 3): This section should be used to make changes to existing records in the EXPERIMENT_SECTION table. For instance, in the case of a rehabilitation event, the DEASSIGN_DATE for all records with the experiment type immediately preceding the new experiment should be set to the ASSIGN_DATE for the new record. Under this heading, there are two columns to be completed for each element. The column on the left should contain the data as it currently exists in the EXPERIMENT_SECTION table and the column on the right should contain the required changes for that record.

CONSTRUCTION_NO: Event number used to relate changes in pavement structure with other time-dependent data elements. This field is set to "1" when a test section is initially accepted into LTPP and is incremented with each construction related change to the pavement. Since the change being applied can be for more than one CONSTRUCTION_NO, the first blank should indicate the lowest CONSTRUCTION_NO requiring the change and the second should indicate the largest CONSTRUCTION_NO being changed. If only one CONSTRUCTION_NO is being changed, only the first blank should be filled in.

CN_ASSIGN_DATE: The assignment date for the beginning of a construction event. It is equal to the acceptance date when a test section is first accepted into the LTPP program, e.g., CONSTRUCTION_NO = 1. It corresponds to the construction activity start date when the pavement layer structure is modified by maintenance or rehabilitation. CN_ASSIGN_DATE is used by the IMS software to assign CNs to records contained in other tables. When a construction event occurs that causes an increment in CONSTRUCTION_NO, CN_ASSIGN_DATE (CN) must be less than or occur before CN_ASSIGN_DATE (CN+1). For changes to more than one CONSTRUCTION_NO, this field should be left blank.

CN_CHANGE_REASON: Code indicating the reason(s) for changing CONSTRUCTION_NO. A numeric code is assigned to the CN_CHANGE_REASON to indicate the type of maintenance or rehabilitation a test section received. Multiple codes may be assigned to indicate various maintenance/rehabilitation treatments a test section received. When multiple codes are entered, they should be separated with commas. Leading zeroes for single digit codes are not used. The codes can be found in appendix A, table A.16.

GPS_SPS: Code indicating if the section is assigned to the GPS (G) or SPS (S).

EXPERIMENT_NO: Indicates which LTPP experiment the pavement section is assigned to. This two-digit code consists of a number followed by an optional suffix letter. The suffix is used for some experiments to indicate a subcategory of test sections.

STATUS: Code indicating the current monitoring status of a section. A null value indicates the test section has been approved and has an active monitoring status. A value of O indicates that the test section has been placed out of study and no future monitoring measurements will be made. This field should only be set to O when a test section goes out of study. At that time, the STATUS field in all records in EXPERIMENT_SECTION with matching STATE_CODE and SHRP_ID should be set to O. A value of R indicates a rejected test section that, due to some fatal flaw, is being removed from the LTPP program and all data entries in the IMS deleted.

ASSIGN_DATE: Date when a test section was assigned to the LTPP experiment. The experiment designation for a test section is the combination of EXPERIMENT_NO and GPS_SPS fields in the record. When a section is first accepted into LTPP, ASSIGN_DATE is the acceptance date. ASSIGN_DATE is the construction start date and should equal the CN_ASSIGN_DATE, e.g., ASSIGN_DATE (CN+1) = CN_ASSIGN_DATE (CN+1) if EXPERIMENT_NO (CN) ? EXPERIMENT_NO (CN+1).

DEASSIGN_DATE: Date when a test section changed to another experiment or was placed in out of study status in the LTPP program (STATUS = O). This field should be null until a rehabilitation construction event occurs which causes a change in EXPERIMENT_NO, or the test section goes out of test. When a test section changes experiments due to rehabilitation, the DEASSIGN_DATE for the previous CN should equal the CN_ASSIGN_DATE for the next CN, e.g., DEASSIGN_DATE (CN) = CN_ASSIGN_DATE (CN+1), if EXPERIMENT_NO (CN) ? EXPERIMENT_NO (CN+1). If a maintenance related construction event occurs that does not result in an experiment change, the DEASSIGN_DATE for the previous CN should equal the DEASSIGN_DATE for the next CN, e.g., DEASSIGN_DATE (CN) = DEASSIGN_DATE (CN+1) (even if null), if EXPERIMENT_NO (CN) = EXPERIMENT_NO (CN+1).

SEAS_ID: State-specific SMP identification code indicating that SMP measurements were made for the corresponding construction number. SEAS_ID is set to A for the first SMP site installed in a State, B for the second site, etc. This field shall only be populated for construction numbers in which SMP data were collected. When a construction event occurs on a SMP test section that results in termination of its participation in the SMP, or if SMP monitoring was previously terminated prior to occurrence of a new construction event, SEAS_ID shall be set to null in the EXPERIMENT_SECTION record corresponding to the new CN for which no SMP data are available.

SUPPLEMENTAL: This field is set to S if the test section is a highway agency supplemental section on SPS project sites.

Test Section Out of Study?: This field should be set to Y if the section is being taken out of study. 'Y' indicates a request to set STATUS for every records for this section in EXPERIMENT_SECTION to 'O.'

Other Change Documentation Attached? (Y/N) (Item 4): If changes concerning the test section status other than those noted above are proposed, provide an explanation under comments in item 5 and enter a Y in the space indicating that the supporting documentation is attached to the form. An explanation and documentation are required for all other changes.

Comments (Item 5): This space is provided for entry of comments or explanations from the requestor on the nature of the requested changes. Additional sheets should be attached to the form if more room is needed or the change requires additional documentation.

Approval Status (Item 6): The approval status of the requested changes is indicated with a check mark in the boxes under this item.

Approval Comments (Item 7): This portion of the form is reserved for comments from the approval authority on actions to be taken to implement changes, explanations of any modifications to the proposed changes, or reason(s) why the proposed changes were not approved.

Requestor and Organization: Form 1 submissions must be signed or submitted by either the Regional Database Manager or the Regional Program Manager.

Approved By: The signature of the party responsible for approving the change to the EXPERIMENT_SECTION table along with the party's organization name and the date the change was approved.

2.1.2 Adding a New Record With an Experiment Change

If a new record is proposed with an accompanying change in experiment, both sections 2 and 3 of form 1 must be completed. In section 2, the CN_ASSIGN_DATE should be equal to the ASSIGN_DATE for the newly created record, and both should equal the date the rehabilitation event started. It is important that the ASSIGN_DATE be set after the date of the last monitoring measurement and prior to or equal to the first day of the construction activity associated with the new CN event.

Data collected after construction events that require a change to a new experiment designation shall not be entered into the IMS until the change to EXPERIMENT_SECTION has been approved and performed. At the very minimum, enough information on the nature of the construction treatments applied to a test section that cause the change in experiment must be supplied with form 1 so that the new experiment designation can be verified.

Section 3 of form 1 must be completed to identify the records that must be given a deassign date due to the assignment of a new experiment to the test section. The DEASSIGN_DATE for all records with the experiment type immediately preceding the new experiment should be set to the ASSIGN_DATE for the new record.

Because a change in experiment requires approval from FHWA for monitoring continuation, this request generally should not be made until form RI-2 has been completed and approved. Therefore, it is expected that a completed form RI-2 will be submitted with all requests to change experiment.

2.1.3 Adding a New Record With No Experiment Change

If a new record is proposed without an accompanying change in experiment, section 2 of form 1 must be filled out. In section 2, the CN_ASSIGN_DATE should be equal to the date the rehabilitation/maintenance started, not the day before. The ASSIGN_DATE should be equal to the ASSIGN_DATE for the previous construction number. Section 3 of form 1 is not required for this operation.

2.2 FORM RI-1, CAUSE FOR REHABILITATION

Rehabilitation Information Form RI-1, Cause for Rehabilitation, shall be submitted to the participating highway agency for completion for all LTPP test sections that are scheduled for rehabilitation. A separate form shall be completed for each test section, even when multiple test sections located on the same project are rehabilitated at the same time. This form should be completed for all test sections scheduled for rehabilitation regardless of whether or not the test section will remain in the LTPP program after rehabilitation.

The following information is requested on the form:

State Code: The State code is the number used to identify the State or the Canadian Province in which the pavement section is located.

LTPP Section ID: The LTPP section ID is the four digit identification number assigned to the test section by the LTPP program. This number is used to facilitate computer referencing and for field identification.

Date: Enter the date the form was completed.

Primary Reason for Rehabilitation (Item 1): Place an X in the box that best describes the primary reason that the test section is being rehabilitated. Rehabilitation can be performed to address pavement condition problems or for other reasons. Since pavement condition problems may exist on the project in which the test section is located and not on the test section itself, the first two boxes are provided to indicate whether or not a pavement condition problem leading to the rehabilitation is present on the test section. The last box is provided to signify that the cause for the planned rehabilitation is not related to a problem with the condition of the pavement.

General Pavement Related Rehabilitation Causes (Item 2): If the reason for rehabilitation is due to a pavement condition problem, the primary general factor affecting the decision to rehabilitate the pavement section should be indicated. This response should be independent of whether or not the problem occurs on the test section. If the rehabilitation cause is not due to a pavement condition problem, do not enter a response. A single response indicating the most significant single factor leading to the rehabilitation decision is desired. The agency can also respond by using a pavement condition index based on a combination of multiple pavement distresses and/or roughness attributes. If the predefined responses are not adequate to describe the primary reason for the planned rehabilitation, then an "other" category is provided that requires a brief explanation of the reason for rehabilitation.

Contributing Pavement Condition Related Rehabilitation Causes (Item 3): Since many contributing pavement condition factors can affect a rehabilitation decision, these can be described under this item. The intent is to include those pavement condition items that contributed to the rehabilitation decision rather than all pavement distresses that may be present. Most of the predefined responses are pavement distress types as defined in the LTPP Distress Identification Manual. If the cause for the rehabilitation is not related to pavement condition, no response should be made in this blank.

Nonpavement Condition Related Reasons (Item 4): If a nonpavement condition reason is the cause for the planned rehabilitation, mark the appropriate box or provide a short explanation under "other."

Scheduled Date for Start of Construction Activities (Item 5): Indicate the month and year that construction activities are scheduled to begin. When possible, indicate the date when construction activities on the portion of the project on which the test section is located are expected to begin.

2.3 FORM RI-2, MONITORING CONTINUATION REQUEST

When the participating highway agency notifies the LTPP that test section rehabilitation is planned, the agency is interested in continuing monitoring activities on the rehabilitated section, and the proposed rehabilitation treatment conforms with current LTPP policy on monitoring continuation of rehabilitated test sections, then a form RI-2 should be completed and submitted with the form RI-1.

It is the responsibility of the LTPP RSC to coordinate with the highway agency to complete form RI-2 and have it signed by a highway agency official. The completed form should be submitted to FHWA with a copy to the LTPP TSSC.

The guidelines for completing the RI-2 are:

State Code: State code is the number used to identify the State or the Canadian Province in which the pavement section is located.

SHRP ID: SHRP ID is the four-digit identification number assigned to the test section by the LTPP program. This number is used to facilitate computer referencing and for field identification.

Date: Enter date when the form was submitted.

Existing Experiment Designation and Pavement Structure (Item 1): Indicate the current experiment designation for the test section. Use G for GPS and S for SPS, the assigned single digit experiment number, and the suffix code as applicable. Please use a P or A suffix code to differentiate between SPS-9P and SPS-9A test sections. For example, if a test section started as a GPS-1, but was subsequently overlaid and is currently in the GPS-6B experiment, a G6B should be entered.

If the test section is in SPS-8, check the box corresponding to the type of pavement structure. If the test section is in SPS-9, check the box corresponding to the type of pavement.

Estimated Rehabilitation Construction Start Date (Item 2): Provide the best available estimate of the planned date for start of rehabilitation construction. Estimates to the nearest month are acceptable.

Proposed Rehabilitation Treatments-AC Surfaced Pavements (Item 3): Check applicable boxes that describe all the rehabilitation treatment activities planned for AC surfaced test sections. Also provide milling depths and overlay thickness as applicable. Provide details under "other" for rehabilitation treatment activities not adequately covered by one of the provided responses. Attach additional pages if more space is needed.

Proposed Rehabilitation Treatments-PCC Surfaced Pavements (Item 4): Check applicable boxes that describe all rehabilitation treatment activities planned for PCC surfaced test sections. If the structure to be rehabilitated is an existing AC overlay on a PCC type pavement, mark any of the treatment activities planned for the PCC layer listed under this item. Provide entries for overlay thickness and debond layer type, as applicable.

Provide details under "other" for rehabilitation treatment activities not adequately covered by one of the provided responses. Attach additional pages if more space is needed.

Other Construction Activities within 300 m of Test Section (Item 5): Check all applicable boxes for other construction activities to be performed within 300 m (985 ft) from either end of the test section. Provide details under "other" for construction activities within or near this zone around the test section that might affect traffic patterns on the test section or its performance, but that are not adequately covered under one of the provided responses. Attach additional pages if more space is needed.

Dates of Last/Planned Monitoring Measurements (Item 6): The RSC shall provide the dates of the last LTPP monitoring measurements performed on the test section. Also, an estimated date for any monitoring planned to be performed before construction must be provided.

Agency Activities: Check all of the activities the agency agrees to perform with respect to the planned rehabilitation and subsequent monitoring. If one of the listed activities is not checked, attach an explanation of the circumstances and how the activity will be accomplished.

Signatures: A highway agency official and the responsible RSC engineer submitting this information must sign the form in the indicated spaces.

Indicate the number of pages of supplemental information included in the data form submission in the space provided.

Copies of IMS forms 1, RI-1, and RI-2 are shown below.



LTPP Test Section Status
IMS Form 1
Test Section Status Change Request
State Code
SHRP ID
Date (dd/mm/yyyy)
[ __ __ ]
[ __ __ __ __ ]
[ __ __ / __ __ / __ __ __ __ ]

1. Region (1 - North Atlantic; 2 - North Central; 3 - Southern; 4 - Western) [ __ ]

2. New Record to be added to EXPERIMENT_SECTION (provide explanation under comments)
CONSTRUCTION_NO [ __ ] EXPERIMENT_NO [ __ __]
CN_ASSIGN_DATE [ __ __ / __ __ __ / __ __ __ __ ] ASSIGN_DATE [ __ __ / __ __ __ / __ __ __ __ ]
CN_CHANGE_REASON [ _ _ _ _ _ _ _ _ _ _ _ _ _ ] SEAS_ID [ __ ]
GPS_SPS [ __ ] SUPPLEMENTAL [ __ ]

3. Changes to existing EXPERIMENT_SECTION record(s) (provide explanation under comments)
  Record to be Changed Proposed Changes
CONSTRUCTION_NO [ __ ] - [ __ ] [ __ ] - [ __ ]
CN_ASSIGN_DATE [ __ __ / __ __ __ / __ __ __ __ ] [ __ __ / __ __ __ / __ __ __ __ ]
CN_CHANGE_REASON [ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ] [ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ]
GPS_SPS [ __ ] [ __ ]
EXPERIMENT_NO [ __ __ ] [ __ __ ]
ASSIGN_DATE  [ __ __ / __ __ __ / __ __ __ __ ] [ __ __ / __ __ __ / __ __ __ __ ]
DEASSIGN_DATE [ __ __ / __ __ __ / __ __ __ __ ] [ __ __ / __ __ __ / __ __ __ __ ]
SEAS_ID [ __ ] [ __ ]
SUPPLEMENTAL [ __ ] [ __ ]
Test section out of study? (Y/N)
CONSTRUCTION_NO must be specified. If only one record, use only first blank.
Codes can be found in Table A.16 of the Data Collection Guide for LTPP Studies.

4. Other change documentation attached? (Y / N) [ __ ]

5. Comments __________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

6. __ Approved as submitted __ Approved changes noted under approval comments __ Not Approved

7. Approval comments____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Requestor _________________________________ Organization ________________________

Approved by _______________________________ Organization ________________________

Approval date ______________________________



LTPP Test Section Rehabilitation
Rehabilitation Information Form RI–
Cause for Rehabilitation
State Code
SHRP ID
Date (dd/mm/yyyy)
[ __ __ ]
[ __ __ __ __ ]
[ __ __ / __ __ / __ __ __ __ ]

1. Primary reason for rehabilitation:
test section pavement condition non-test section pavement condition not related to pavement condition

2. General pavement related rehabilitation causes (check the one most important factor)
pavement distress roughness friction agency condition index
Other _________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

3. Contributing pavement condition related rehabilitation causes (check all that apply)
wheel path cracking rutting roughness surface friction
non-wheel path cracking shoving faulting polished aggregate
raveling bleeding scaling potholes
joint spalling punchouts condition index  
Other _________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

4. Non-pavement condition related reasons (check all that apply)
added lane route realignment  adjacent land use changes
political related causes    
Other _________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

5. Scheduled date for start of construction activities (mm/yyyy) [ __ __ / __ __ __ __ ]

Agency Contact Name ____________________ Employer:____________________________

Phone Number: ______________________ E-mail:__________________________________



LTPP Test Section Rehabilitation
Rehabilitation Information Form RI—
Monitoring Continuation Request
State Code
SHRP ID
Date (dd/mm/yyyy)
[ __ __ ]
[ __ __ __ __ ]
[ __ __ / __ __ / __ __ __ __ ]

1. Existing experiment designation and pavement type ( {G-GPS; S-SPS}/ # / suffix – if applicable) [ __ __ __ ]
SPS-8 pavement structure: Asphalt Concrete; Portland cement concrete
SPS-9 pavement structure: New / reconstructed; Overlay

2. Estimated rehabilitation construction start date (dd/mm/yyyy) [ __ __ / __ __ / __ __ __ __ ]

3. Proposed rehabilitation treatments – AC surface pavements
Pre-overlay treatments: None Patching Heater-scarification Fabric Milling – Total Depth ____mm
Overlay thickness _____ mm
Overlay material: Conventional virgin HMA mixture Recycled HMA mixture HMA with modified binder
Plain jointed PCC Jointed reinforced PCC Continuously reinforced PCC
Other _________________________________________

4. Proposed rehabilitation treatments – PCC pavements
CPR treatments without overlay Overlay – thickness __________ mm
Pre-overlay treatments: Partial depth patching ; Full depth patching and joint/crack replacement Undersealing
Load Transfer Restoration Retrofitted subsurface drainage system Crack/Break & Seat Rubblization
Full Surface Diamond Grinding Debond Interlayer: Type __________________________________
Overlay material: Conventional virgin HMA mixture Recycled HMA mixture HMA with modified binder
Plain jointed PCC Jointed reinforced PCC Continuously reinforced PCC Saw and seal HMA overlay layer
Other _________________________________________

5. Other construction activities within 300-m of test section
Widening of the LTPP test lane Lane added next to LTPP test lane Intersection or ramps
Tied concrete shoulder Traffic signal  
Other

6. Dates of last/planned monitoring measurements: Last Measurements Performed Planned Measurements
Prior to Rehabilitation
Deflection (mm/yyyy) [ __ __ / __ __ __ __ ] [ __ __ / __ __ __ __ ]
Distress (manual or PASCO) (mm/yyyy) [ __ __ / __ __ __ __ ] [ __ __ / __ __ __ __ ]
Profile (mm/yyyy) [ __ __ / __ __ __ __ ] [ __ __ / __ __ __ __ ]
Agency activities. The highway agency agrees to provide: check all applicable
Onsite traffic monitoring Monitoring measurement traffic control; Mark and sign test section
Materials field sampling and testing Rehabilitation construction data Notification prior to construction
Signatures Highway agency official and RSC Engineer must sign verifying information
Highway Agency Official
Name: _______________ Organization ________________ Signature _________________
RSC Engineer
Name: _______________ Organization ________________ Signature _________________
9. Attached number of pages [ __ __ ]

Rehabilitation Information Form RI— September 1998

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