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["WEST VIRGINIA DIVISION OF HIGHWAYS "]
["INSPECTION OF STRUCTURAL WORK"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"WVDOH LAB NUMBER:"]
[]
["TYPE OF REPORT:",null,null,"INTERIM",null,null,null,null,"TRANSFER TO",null,null,null,null,null,"FINAL"]
[]
["REPORT NUMBER: ",null,null,null,null,null,"SHEET",null,null,"OF",null,null,"FABRICATOR JOB NO.: "]
[]
["FABRICATOR:"]
[]
["PROJECT:",null,null,null,null,null,null,null,null,null,null,null,"         BRIDGE NUMBER:"]
[]
["AUTHORIZATION NUMBER:",null,null,null,null,null,null,null,null,null,null,null,null,null,"DATE:"]
[]
["INSPECTOR:",null,null,null,null,null,null,null,null,null,null,null,"           AGENCY:"]
[]
["DESCRIPTION",null,null,"NUMBER REQUIRED",null,null,"NUMBER ACCEPTED",null,"# ACCEPTED TO DATE",null,null,null,"DESCRIPTION",null,"NUMBER REQUIRED",null,"NUMBER ACCEPTED",null,"# ACCEPTED TO DATE"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["COMPONENT ACCEPTANCE APPROVAL NUMBERS:"]
[]
["HIGH STRENGTH BOLTS:",null,null,null,null,null,null,null,null,null,null,null,"            PAINT:"]
[]
["SHEAR STUDS:",null,null,null,null,null,null,null,null,null,null,null,"PAINT QUALITY CONTROL PLAN:"]
[]
["SUBCONTRACTED MATERIAL:"]
[]
[]
["THE FOLLOWING DOCUMENTS NECESSARY FOR INSPECTION HAVE BEEN RECEIVED:"]
[]
["PLANS AND PROPOSALS:",null,null,null,null,null,null,null,null,null,"DATE SHOP DRAWINGS APPROVED:"]
[]
["APPROVED WELD PROCEDURES:"]
[]
["Material covered by this report has been inspected and found to comply with the requirements of the West Virginia Standard"]
["Specifications for Roads and Bridges adopted",null,null,null,null,null,null,null,null,null,null,null,"and Supplemental Specifications dated",null,null,null,null,null,null,","]
["proposals, contract plans, and approved shop drawings."]
[]
["Mill test reports have been reviewed for proper grade of steel, for acceptable physical and chemical properties, and for the \"Made in"]
["USA\" statement.  This review was jointly made with the Quality Control Section of the fabrication shop.  These mill test reports are "]
["attached",null,null,null,null,"or previously submitted under approval/lab number",null,null,null,null,null,null,null,null,null,null,null,".  If this material was"]
["transferred from another shop, the WVDOH approval number assigned to the material at that shop was",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"."]
[]
["Material accepted bears our agency's stamp of acceptance."]
[]
[null,null,"Signature:"]
[]
[null,null,"Printed Name:"]
["Distribution:"]
[null,null,"Original: West Virginia DOH Authorizing Personnel"]
["Form HS-10 (Revised 08/10)"]

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