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CS-431 6-07 STRUCTURAL MATERIAL TRANSFER FORM In stru ctions on Page 2 To PENNDOT INSPECTOR AND/OR RECEIVING COMPANY Date Transferred To Company Name Inspector s Name Inspector s Signature Inspection Agency Phone Fax Number of attached pages Attach copies of bill of lading shipping form for all pieces. 1. Proj ect Info rmat io n E C M S N u mb er SYS SR SPUR PHA SECT ORGN* ALLOT COST FUNC STRUCTURE COUNTY 2. M a t er ia l d es c r ip t io n S e e a tta ched Or lis t h er e 3. Mat eria l Tr ansfer R eason Ch eck one or mo re Facility Lo cation Ga lv an izing Pain ting Ma ch in ing S tor age O ther 4. L i st a ny o ut st a n d ing de v ia t ion s o r d ef i c ie nc ie s w h ic h wou l d p r even t t h e mat er i a l f ro m be i ng a cc ep t ed a t t h e t im e o f t ra n sf er. In clude Quality Repor t nu mb er s if app licab le. Q R Nu mb er s D e scr ip tion of dev iations 1 of 2 INSTRUCTIONS FOR This form should be filled and signed by the inspector working at the fabrication shop when fabricated material is transferred to another shop or facility for additional work. Header 1. Enter Date Material s shipped* 2. Enter the Company Name the material is being shipped to. 3. Print your name and sign the form* 4. Enter your Inspection Agency name and provide a phone number which you can be reached in the event another inspector has questions or requires additional information and your Fax number if available. required and enter the number of pages you attached to this form* Section 1 8. Enter the ECMS No* and the State Project Number use the information supplied by EQMS* 9. Briefly describe the material s being transferred* 10. Identify the subsequent operation s to be performed for which the material is being transferred* should be aware of* Reference and list Quality reports when applicable. 1. Proj ect Info rmat io n E C M S N u mb er SYS SR SPUR PHA SECT ORGN* ALLOT COST FUNC STRUCTURE COUNTY 2. M a t er ia l d es c r ip t io n S e e a tta ched Or lis t h er e 3. Mat eria l Tr ansfer R eason Ch eck one or mo re Facility Lo cation Ga lv an izing Pain ting Ma ch in ing S tor age O ther 4. M a t er ia l d es c r ip t io n S e e a tta ched Or lis t h er e 3. Mat eria l Tr ansfer R eason Ch eck one or mo re Facility Lo cation Ga lv an izing Pain ting Ma ch in ing S tor age O ther 4. L i st a ny o ut st a n d ing de v ia t ion s o r d ef i c ie nc ie s w h ic h wou l d p r even t t h e mat er i a l f ro m be i ng a cc ep t ed a t t h e t im e o f t ra n sf er. L i st a ny o ut st a n d ing de v ia t ion s o r d ef i c ie nc ie s w h ic h wou l d p r even t t h e mat er i a l f ro m be i ng a cc ep t ed a t t h e t im e o f t ra n sf er. In clude Quality Repor t nu mb er s if app licab le. Q R Nu mb er s D e scr ip tion of dev iations 1 of 2 INSTRUCTIONS FOR This form should be filled and signed by the inspector working at the fabrication shop when fabricated material is transferred to another shop or facility for additional work. In clude Quality Repor t nu mb er s if app licab le. Q R Nu mb er s D e scr ip tion of dev iations 1 of 2 INSTRUCTIONS FOR This form should be filled and signed by the inspector working at the fabrication shop when fabricated material is transferred to another shop or facility for additional work. Header 1. Enter Date Material s shipped* 2. Enter the Company Name the material is being shipped to.

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