Form CEM-4102 "Material Inspected and Released on Job" - California

What Is Form CEM-4102?

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

Form Details:

  • Released on July 1, 1995;
  • The latest edition provided by the California 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 fillable version of Form CEM-4102 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-4102 "Material Inspected and Released on Job" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
JOB STAMP
MATERIAL INSPECTED AND RELEASED ON JOB
CEM-4102 (NEW 7/1995)
MATERIAL
ITEM NUMBER
SUPPLIER
DATE OF INSPECTION
QUANTITY INSPECTED (#/ UNIT)
BASIS FOR ACCEPTANCE - (INITIAL EACH CATEGORY)
1. CERTIFICATION OF COMPLIANCE (ATTACHED)
2. TEST RESULTS FROM MANUFACTURE (ATTACHED)
3. CERTIFICATE OF BUY AMERICA, AS APPLICABLE
4. VISUAL INSPECTION FOR OVERALL QUALITY, WORKMANSHIP, VERIFICATION OF MARKINGS
5. OTHER (EXPLAIN)
REMARKS:
INSPECTED BY:
RESIDENT ENGINEER SIGNATURE
CEM4102
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916)
ADA Notice
654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
JOB STAMP
MATERIAL INSPECTED AND RELEASED ON JOB
CEM-4102 (NEW 7/1995)
MATERIAL
ITEM NUMBER
SUPPLIER
DATE OF INSPECTION
QUANTITY INSPECTED (#/ UNIT)
BASIS FOR ACCEPTANCE - (INITIAL EACH CATEGORY)
1. CERTIFICATION OF COMPLIANCE (ATTACHED)
2. TEST RESULTS FROM MANUFACTURE (ATTACHED)
3. CERTIFICATE OF BUY AMERICA, AS APPLICABLE
4. VISUAL INSPECTION FOR OVERALL QUALITY, WORKMANSHIP, VERIFICATION OF MARKINGS
5. OTHER (EXPLAIN)
REMARKS:
INSPECTED BY:
RESIDENT ENGINEER SIGNATURE
CEM4102
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916)
ADA Notice
654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.