Form BLR 13310 Certification of Local Public Agency Material Test Procedures - Illinois

Form BLR13310 is a Illinois Department of Transportation form also known as the "Certification Of Local Public Agency Material Test Procedures". The latest edition of the form was released in October 4, 2017 and is available for digital filing.

Download an up-to-date Form BLR13310 in PDF-format down below or look it up on the Illinois Department of Transportation Forms website.

ADVERTISEMENT
Certification of Local Public Agency
Material Test Procedures
The following describes the educational background, training and work experience of
Name
who is an employee of the local public agency of
and is to be in responsible charge
Name of Local Public Agency
of the lab and/or field material test(s) specified below.
List the education background, training and work experience that qualifies the individual to perform the test specified.
Name of material test(s) the individual will perform.
As a qualified representative of the Local Public Agency I certify that the test(s) specified will be performed and documented in
accordance with IDOT policy and that adequate equipment is available for the test(s) specified.
Local Public Agency
Date
A qualified representative of the local public agency must be a public employee and a licensed Professional Engineer in the State of
Illinois and defined as a County Engineer/Superintendent of Highways, Public Works Director or a Municipal Engineer.
Printed 06/05/19
Page 1 of 1
BLR 13310 (Rev. 10/04/17)
Certification of Local Public Agency
Material Test Procedures
The following describes the educational background, training and work experience of
Name
who is an employee of the local public agency of
and is to be in responsible charge
Name of Local Public Agency
of the lab and/or field material test(s) specified below.
List the education background, training and work experience that qualifies the individual to perform the test specified.
Name of material test(s) the individual will perform.
As a qualified representative of the Local Public Agency I certify that the test(s) specified will be performed and documented in
accordance with IDOT policy and that adequate equipment is available for the test(s) specified.
Local Public Agency
Date
A qualified representative of the local public agency must be a public employee and a licensed Professional Engineer in the State of
Illinois and defined as a County Engineer/Superintendent of Highways, Public Works Director or a Municipal Engineer.
Printed 06/05/19
Page 1 of 1
BLR 13310 (Rev. 10/04/17)
Instructions for BLR 13310
This form shall be used for all Motor Fuel Tax (MFT) or State funded projects where the Local Public Agency will be performing
material inspections and tests. For more information see Chapter 13 of the Bureau of Local Roads and Street Manual(BLRS Manual).
For signature requirements, refer to Chapter 2, Section 3.05(b) of the BLRS Manual.
Name
Insert the name of the person to be certified to conduct material tests.
Local Public Agency
Insert the name of the Local Public Agency (LPA).
Background
Insert the educational background, training and work experience that qualifies the individual to
perform test(s) specified.
Material Test
Insert the material test(s) this person will perform. (e.g., aggregate graduations, air test, slump
test, etc.).
Signature
The LPA professional engineer shall sign here. For county this will be the county engineer, for a
municipality it
Date
Insert the date of the signature.
A minimum of two (2) signed originals must be submitted to the Regional Engineer's District office.
Distribution will be as follows:
LPA Engineer
District File
Printed 06/05/19
BLR 13310 (Rev. 10/04/17)

Download Form BLR 13310 Certification of Local Public Agency Material Test Procedures - Illinois

965 times
Rate
4.8(4.8 / 5) 48 votes
ADVERTISEMENT
Page of 2