PAGE 1 OF 1Michigan Department

of Transportation 1452 (05/19)

TRUSS, TYPE C & DINSTALLATION INSPECTION REPORT

To be completed in conjunction with Truss, Type C & D InstallationInspection Procedure and submitted to the Structural Fabrication Unit.

File Naming Convention: 1452 SN-CS-JN Date.pdf

GENERAL INFORMATIONSTRUCTURE # CONTROL SECTION JOB NUMBER DATE

REGION COUNTY ROUTE

LOCATION DESCRIPTION

GPS LAT______________________________ __________ ○

GPS LONG__________________________________ ____ ○

STRUCTURE INFORMATION

TRUSSSTANDARD PLAN #

SIGN CONNECTION STANDARD PLAN #

FOUNDATION STANDARD PLAN #

SIGN LEGEND

VISUAL INSPECTION

CHORD TO UPRIGHT CONNECTIONWELDSBOLTS

STRUCTURE BASE & FOUNDATIONWELDSFOUNDATION

CHORD TO CHORD CONNECTION BOLTSANCHOR BOLT ID # LH

RH

ANCHOR BOLT INSPECTION (LH/RH)1 2 3 4 5 6 7 8

SOUNDINGANCHOR NUTS

1 2 3 4 5 6 7 8ANCHOR BOLTPROJECTION (P)

1 2 3 4 5 6 7 8STAND-OFFDISTANCE (S)

1 2 3 4 5 6 7 8ULTRASONICTESTING

REMARKS

INSPECTOR COMPANY