Form 313-AF4 "Core Request Form" - Rhode Island

What Is Form 313-AF4?

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

Form Details:

  • Released on January 21, 2021;
  • The latest edition provided by the Rhode Island 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 313-AF4 by clicking the link below or browse more documents and templates provided by the Rhode Island Department of Transportation.

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Download Form 313-AF4 "Core Request Form" - Rhode Island

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Materials Lab No: _______________ (Lab use only)
RHODE ISLAND DEPARTMENT OF TRANSPORTATION
MATERIALS MANAGEMENT
CORE REQUEST FORM
RI Contract No:
F.A.P. No:
PTSID:
Project Name:
Date:
Project Limits:
Project Town/City:
I. Project Details
i. Type of cores:
HMA
Concrete
ii. Project Length:
miles
iii. Number of Travel Lanes:
iv. Lane Width:
feet
v. Include Shoulders:
Yes
No
vi. Shoulder Width:
feet
vii. Location of cores:
Marked Plans
Random Method
viii. Initial Rideability Required?
Yes
No
II. Explanation
i. Reason for Request:
(Please Check)
Prelim. Eng.
Density
Final
Other
Describe:
ii. Indicate Pavement Structure:
Explain pavement structure, if known, and indicate layer(s) to be tested.
iii. Indicate Quantity and Size of Cores:
Number:
Diameter:
(Cores are 4” unless otherwise specified)
iv. Instructions or Special Notes:
Explain testing/analysis to be performed (i.e. bulk specific gravity, pictures, gravel analysis, etc.)
III. Sample Disposition
i. After Testing:
Keep Samples
Dispose of Samples
Results Issued/Returned To:
Are there known environmental hazards on or near the project site?
Yes
No
If yes, please identify the nature of the hazards on a separate sheet. Please provide a health and safety plan for
working in the area, if available.
NOTE: Under no circumstances will a core request be processed unless this information is provided. With this
information, it will be determined whether Materials personnel can safely collect and test samples.
Requested By
Section
Date
Reviewed By
Date
(Print / Sign)
(Print / Sign)
(Materials Engineer)
ID# AF4 - 313
REV. 1/21/21
Materials Lab No: _______________ (Lab use only)
RHODE ISLAND DEPARTMENT OF TRANSPORTATION
MATERIALS MANAGEMENT
CORE REQUEST FORM
RI Contract No:
F.A.P. No:
PTSID:
Project Name:
Date:
Project Limits:
Project Town/City:
I. Project Details
i. Type of cores:
HMA
Concrete
ii. Project Length:
miles
iii. Number of Travel Lanes:
iv. Lane Width:
feet
v. Include Shoulders:
Yes
No
vi. Shoulder Width:
feet
vii. Location of cores:
Marked Plans
Random Method
viii. Initial Rideability Required?
Yes
No
II. Explanation
i. Reason for Request:
(Please Check)
Prelim. Eng.
Density
Final
Other
Describe:
ii. Indicate Pavement Structure:
Explain pavement structure, if known, and indicate layer(s) to be tested.
iii. Indicate Quantity and Size of Cores:
Number:
Diameter:
(Cores are 4” unless otherwise specified)
iv. Instructions or Special Notes:
Explain testing/analysis to be performed (i.e. bulk specific gravity, pictures, gravel analysis, etc.)
III. Sample Disposition
i. After Testing:
Keep Samples
Dispose of Samples
Results Issued/Returned To:
Are there known environmental hazards on or near the project site?
Yes
No
If yes, please identify the nature of the hazards on a separate sheet. Please provide a health and safety plan for
working in the area, if available.
NOTE: Under no circumstances will a core request be processed unless this information is provided. With this
information, it will be determined whether Materials personnel can safely collect and test samples.
Requested By
Section
Date
Reviewed By
Date
(Print / Sign)
(Print / Sign)
(Materials Engineer)
ID# AF4 - 313
REV. 1/21/21