Form MTRB MC "Request for Letter of Material Certification" - Hawaii

What Is Form MTRB MC?

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

Form Details:

  • Released on June 1, 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 MC 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 MC "Request for Letter of Material Certification" - Hawaii

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MTRB MC 6/16
To:
MATERIALS TESTING & RESEARCH BRANCH
Highways Division, State Department of Transportation
2530 Likelike Highways, Honolulu, Hawaii 96819-2928
From: Name of Requestor __________________________________ Date ______________
Company / Agency ______________________________________________________
E-Mail Address ____________________________ Telephone No. (
)
Subject:
REQUEST FOR LETTER OF MATERIAL CERTIFICATION
Project:
Project No.: ___________________________________________________________________
We request that the “Letter of Material Certification” be issued for the subject project. The
results of tests, samples, and other documentation for the project indicate that the materials
incorporated in the project were in conformity with the contract requirements. In order to verify
acceptability of materials we have checked the following:
1 All Sampling and Testing has been completed in accordance with the contract documents, the
Materials Testing and Research Branch (MTRB) Quality Assurance Manual and the
Sampling and Testing Guide for Acceptance and Verification. The acceptance testing
frequency for all contract items is in substantial conformance with the minimum testing
requirements and the contract. Certificates of Compliance from the manufacturer were
submitted for all required items.
☐ In Conformance or ☐ A list of exceptions to the material acceptance program is
attached with explanations or justifications of why the
materials were accepted even though the material failed to
meet specifications and/or testing did not follow procedures in
the Quality Assurance Manual.
2 Copies of lab results of all samples tested at other AMRL certified labs or district labs were
sent to central lab throughout construction of the project.
☐ Already Submitted or ☐ Copies attached (include explanation of why not
submitted during construction)
3 Copies of all Contract Change Orders were sent to central Lab or are filed on DOTCMS
☐ Already Submitted
☐ Copies on DOTCMS
☐ Copies attached
or
or
4 A copy of the Project’s Summary of Materials is attached to this request. This is a summary
(by item number) of sample cards transmitted to MTRB for each contract item (including
incidentals) that have material specifications.
☐ Attached
Resident Engineer
Date
MTRB MC 6/16
To:
MATERIALS TESTING & RESEARCH BRANCH
Highways Division, State Department of Transportation
2530 Likelike Highways, Honolulu, Hawaii 96819-2928
From: Name of Requestor __________________________________ Date ______________
Company / Agency ______________________________________________________
E-Mail Address ____________________________ Telephone No. (
)
Subject:
REQUEST FOR LETTER OF MATERIAL CERTIFICATION
Project:
Project No.: ___________________________________________________________________
We request that the “Letter of Material Certification” be issued for the subject project. The
results of tests, samples, and other documentation for the project indicate that the materials
incorporated in the project were in conformity with the contract requirements. In order to verify
acceptability of materials we have checked the following:
1 All Sampling and Testing has been completed in accordance with the contract documents, the
Materials Testing and Research Branch (MTRB) Quality Assurance Manual and the
Sampling and Testing Guide for Acceptance and Verification. The acceptance testing
frequency for all contract items is in substantial conformance with the minimum testing
requirements and the contract. Certificates of Compliance from the manufacturer were
submitted for all required items.
☐ In Conformance or ☐ A list of exceptions to the material acceptance program is
attached with explanations or justifications of why the
materials were accepted even though the material failed to
meet specifications and/or testing did not follow procedures in
the Quality Assurance Manual.
2 Copies of lab results of all samples tested at other AMRL certified labs or district labs were
sent to central lab throughout construction of the project.
☐ Already Submitted or ☐ Copies attached (include explanation of why not
submitted during construction)
3 Copies of all Contract Change Orders were sent to central Lab or are filed on DOTCMS
☐ Already Submitted
☐ Copies on DOTCMS
☐ Copies attached
or
or
4 A copy of the Project’s Summary of Materials is attached to this request. This is a summary
(by item number) of sample cards transmitted to MTRB for each contract item (including
incidentals) that have material specifications.
☐ Attached
Resident Engineer
Date