WINTER CHEMICAL CERTIFICATION CHECKLIST

GENERAL

The Winter Chemical Approval Checklist has been put together to aid Producers and Manufactures in compiling your approval packet. Include a copy of the checklist with your submittal. The processing of your request will be put on hold until all the approval information and samples are received. Certification information should be submitted to:

Iowa DOT – Office of Construction and Materials 

800 Lincoln Way

Ames, IA 50010.

Attn: Manufactured Materials Engineer

CERTIFICATION CHECKLIST

1. Certification Statement

Submitted by:	Date:
Company:
Address:
Contact Person:	Phone:	(	)
Name of chemical/product for prescreen:

Note: A separate checklist must be completed for each product submitted.

2. Written certification is needed by a responsible company officer that the following chemicals are not contained in the product:

Chlorinated Dioxins

Chlorinated Furans

Polychlorinated Biphenyls (PCBs)

Octachlorostyrene

Hexavalent Chromium

Polynuclear Aromatic Hydrocarbons

Radioactive materials

Registered Pesticides

3. PNS Testing Report and Data

The name of the product and the strength of the solution tested must be clearly stated on each laboratory report.

Status on the Pacific Northwest Snowfighters Qualified Products List

Date Test Status:

Date Approved:

4. Safety Data Sheet for product and corrosion inhibitor (if applicable).

5. Product Data Sheet, needs to include the tests listed in bullet 6 and results of bullet 7. Typical shelf life and applicable storage conditions for the product as well as pH data (if applicable) for liquid products must be also provided.

6. The following tests shall be done in accordance with the testing methodology listed in the Pacific Northwest Snowfighters’ specifications. Include lab test reports and data.

Ammonia – Nitrogen

Total Kjeldahl Nitrogen

Nitrate and Nitrite as Nitrogen

Biological Oxygen Demand

Chemical Oxygen Demand

Frictional Analysis

Toxicity Testing:

Fathead Minnow Growth and Survival Bioassay

Ceriodaphnia Dubia Reproductive and Survival Bioassay

Selenastrum Capricornutum Algal Growth

7. List of Chemical Constituents in Product

Provide the product composition of the following elements. If the product is premixed with salt brine, provide the concentrations for both the salt brine alone and the finished premixed product. Testing must be done by a certified and independent laboratory. The product chemical composition should not exceed the specification limits.

Cyanide*

Arsenic

Barium

Cadmium*

Chromium*

Copper

Lead

Mercury

Selenium*

Zinc*

Phosphorus

Magnesium

Sulfate ion as (SO₄)

8. Provide recommended field application rates (e.g., dilution, pretreatment technique, and application technique).

9. Explain how the new product fulfills an existing need or added value to our current Iowa DOT’s winter chemical toolkit.

10. References and contact information for agencies currently using the product.

No product shall be submitted unless it is at least 70% less corrosive than sodium chloride (excluding additives to salt brine) using the National Association of Corrosion Engineers (NACE) Standard TM-01-69 (1995 rev.), modified to use 30ml of a 3% chemical product solution per square inch of coupon surface area. Test data and certification that the material meets corrosion criteria must be included.

11. Lab Samples.

The Iowa DOT requires three- 8 ounce liquid samples or two (2) pounds of the dry chemical samples that must be submitted to the Iowa DOT’s Central Materials Laboratory. The samples must be clearly labeled and a copy of the Material Safety Data Sheet and product data sheet should be included.

Please use the sample label supplied below on all samples submitted to the Iowa DOT’s Central Materials Lab for testing. The sample label should be filled out and attached to each sample submitted to ensure that your product can be processed upon receipt.

SAMPLE LABEL

Vendor:	Date:
Address:
Contact Name:
Phone Number:
Product Name:

Remember to include the Product Data Sheet