Form MTRB JC-1 "Transmittal for Material Review/Testing" - Hawaii

What Is Form MTRB JC-1?

This is a legal form that was released by the Hawaii Department of Transportation - a government authority operating within Hawaii. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on January 11, 2016;
  • The latest edition provided by the Hawaii 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 MTRB JC-1 by clicking the link below or browse more documents and templates provided by the Hawaii Department of Transportation.

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Download Form MTRB JC-1 "Transmittal for Material Review/Testing" - Hawaii

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MTRB JC-1 1/11/16
STATE OF HAWAII DEPARTMENT OF TRANSPORTATION MATERIALS TESTING & RESEARCH BRANCH
HWY-LR
District Lab
HWY-LB
TRANSMITTAL FOR MATERIAL REVIEW/TESTING
HWY-LS
HWY-LG
Resubmittal?
for:
For Information Only
Sample No:
JC-
Project No:
Date:
Project:
Island:
Sample of:
Pavement M arking
Copies/Documents
Certificate of Compliance
Quantity of Material Submitted
Bars/Strands
Bags
Pavement Core
(
lbs each)
Other:
Manufacturer or Brand:
Source of Supply:
Material is used for:
Information required for Material Samples Submittals only
Sampled By:
Date Sampled:
Where Sampled:
Date Shipped to HWY-L/District Lab:
Quantity Represented:
Determine suitability under:
Contract Special Provisions
Standard Specifications for Road and Bridge Construction
(attach CCO for HWY-L reference)
Standard Plans
Project Plans
Other:
Spec. Section/Sheet
Payment Item No.:
Remarks:
Report any other pertinent facts below:
Submitted by:
Agency:
Phone Number:
E-Mail
For HWY-L and District Lab Use
Accep ted
Accepted Subject to Conditions
Rejected
Returned for Corrections
Acknowledged
Comments:
Yes
No
Additional Comments Attached:
Contact Name/E-Mail
Reviewer
Date
MTRB JC-1 1/11/16
STATE OF HAWAII DEPARTMENT OF TRANSPORTATION MATERIALS TESTING & RESEARCH BRANCH
HWY-LR
District Lab
HWY-LB
TRANSMITTAL FOR MATERIAL REVIEW/TESTING
HWY-LS
HWY-LG
Resubmittal?
for:
For Information Only
Sample No:
JC-
Project No:
Date:
Project:
Island:
Sample of:
Pavement M arking
Copies/Documents
Certificate of Compliance
Quantity of Material Submitted
Bars/Strands
Bags
Pavement Core
(
lbs each)
Other:
Manufacturer or Brand:
Source of Supply:
Material is used for:
Information required for Material Samples Submittals only
Sampled By:
Date Sampled:
Where Sampled:
Date Shipped to HWY-L/District Lab:
Quantity Represented:
Determine suitability under:
Contract Special Provisions
Standard Specifications for Road and Bridge Construction
(attach CCO for HWY-L reference)
Standard Plans
Project Plans
Other:
Spec. Section/Sheet
Payment Item No.:
Remarks:
Report any other pertinent facts below:
Submitted by:
Agency:
Phone Number:
E-Mail
For HWY-L and District Lab Use
Accep ted
Accepted Subject to Conditions
Rejected
Returned for Corrections
Acknowledged
Comments:
Yes
No
Additional Comments Attached:
Contact Name/E-Mail
Reviewer
Date