Form BR69 "Asphalt Mixture (Hma/Wma) Pavement Quality Indicator (Pqi) Density Data - Continuation Sheet" - New York

What Is Form BR69?

This is a legal form that was released by the New York State Department of Transportation - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2021;
  • The latest edition provided by the New York State Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form BR69 by clicking the link below or browse more documents and templates provided by the New York State Department of Transportation.

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Download Form BR69 "Asphalt Mixture (Hma/Wma) Pavement Quality Indicator (Pqi) Density Data - Continuation Sheet" - New York

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BR 69 (1/2021)
Page
of
MATERIALS BUREAU
Asphalt Mixture (HMA/WMA)
Pavement Quality Indicator (PQI) Density Data – Continuation Sheet
Contract #:
Date:
Location:
Gauge Serial #:
Route #:
Gauge Offset:
Operator’s Name:
Project Target Density (PTD):
Min. Avg. Single Test (0.97*PTD):
Min. Avg. of Last 10 (0.98*PTD):
Inspector’s
Average
Moving
In-Place Pavement Density Measurements (lbs./ft³)
Date of
Station
Initials
Lane
Offset
PQI
Avg. of
(if test
Paving
No.
1
2
3
4
5
Density
Last 10
observed)
Operator’s Signature:
Reviewed by:
(copy with original signature must be submitted to the EIC at the end of the day’s paving)
BR 69 (1/2021)
Page
of
MATERIALS BUREAU
Asphalt Mixture (HMA/WMA)
Pavement Quality Indicator (PQI) Density Data – Continuation Sheet
Contract #:
Date:
Location:
Gauge Serial #:
Route #:
Gauge Offset:
Operator’s Name:
Project Target Density (PTD):
Min. Avg. Single Test (0.97*PTD):
Min. Avg. of Last 10 (0.98*PTD):
Inspector’s
Average
Moving
In-Place Pavement Density Measurements (lbs./ft³)
Date of
Station
Initials
Lane
Offset
PQI
Avg. of
(if test
Paving
No.
1
2
3
4
5
Density
Last 10
observed)
Operator’s Signature:
Reviewed by:
(copy with original signature must be submitted to the EIC at the end of the day’s paving)