Matls IM 204 App Z, Revised 4/18/2023

Sampling & Testing Guide-Minimum Frequency
October 18, 2022		SUPPLEMENTAL GUIDE – BASIS OF ACCEPTANCE							Matls. IM 204
Supersedes April 19, 2022									Appendix Z
Material	IM		Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification		Other Details
Admixture-Air Entraining	403		T. Hanson	4103	1 pt.	DME or RCE	Approved Brand Name (Lot)	Project		Contact District Matls.
Admixture-Corrosion Inhibitor	402		T. Hanson	4103	1 pt.	DME or RCE	Approved Brand Name (Lot)	Project		Contact District Matls.
Admixture-Retarder	403		T. Hanson	4103	1 pt.	DME or RCE	Approved Brand Name (Lot)	Project		Contact District Matls.
Admixture-Water Reducer	403		T. Hanson	4103	1 pt.	DME or RCE	Approved Brand Name (Lot)	Project		Contact District Matls.
Aggregates-Non-proportioned	209		B. Gossman	4110-4133	IM 301	DME/PROD.	Approved Source/Certified Truck Tickets, (Form #821278)	Source		Certified Ticket for pay items by weight
Aggregates-Proportioned	209 & 204		B. Gossman	4110-4133	IM 301	CONTR, RCE, DME	Approved Source/Certified Truck Tickets, (Form #821278)	Source Project
Aluminum, Structural			K. Frame	4190.01			Approved Shop Drawing & Inspection Report
Anchor Bolts & Swedge Anchor	453.08		K. Frame	2522.03, E,4 4185.02, B 4187.01, C	1 bolt, nut & washer per size, per source, per year	DME	Approved Source/Test Report/Steel Mill Certifications	Project
Anchors, Concrete	453.09		T. Hanson				Approved Brand Name
Anti-Strip Agent	491.16		C. Brakke				Approved Brand Name
Arrow Boards, Solar-Assisted (Interstate)	486.12		C. Burke	2528.03, G, 4188.10 F			Approved Brand Name			Standard arrow boards shall meet 4188.10 A, B, C, D, E
Arrow Boards, Smart	486.12		C. Burke	4188.10			Approved Brand Name
Asphalt Binder	437		C. Brakke	4137	1 4-oz. tin	CONTR/DME	Approved Source/Certification Statement /Test Rpt.	Source Project
Asphalt, Cutback	437		C. Brakke	4138	1 qt. tin	RCE	Approved Source/Certification Statement /Test Rpt.	Source
Asphalt, Emulsified	437		C. Brakke	4140	1 qt. bottle	RCE	Approved Source/ Certification Statement /Test Rpt.	Source		Project verification for seal coat
Attenuators, Guardrail			K. Frame				As per plan
Attenuators – see crash cushion
Backer Rod for Cold Pour Joint Seal	436.04		S. Sommers	4136.02, B			Approved Brand Name
Backer Rod for Hot Pour Joint Seal	436.04		S. Sommers	4136.02, B			Approved Brand Name
Barrier Rail, Permanent Precast Concrete	571		M. Khoda	2419, 2513			Approved Source/DOT Stamp/Inspection Report/Certification Statement	Source

Material	IM	Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification	Other Details
Barrier Rail, Temporary Precast Concrete	571	M. Khoda	2419, 2513			Approved Source/Fabricator’s trademark/ Date of Manufacture
Bearing, Bronze		K. Frame	4190.03	1/project	DME	Test Report	Project
Bearing, Lead		K. Frame	4195.01			Certification Statement
Bearing, Neoprene	495.03	S. Sommers	4195.02	1/100 plain or laminated pads	DME	Approved Source	Source
Bentonite Clay		J. De Vries	2501.03, Q			Visual Approval by RCE
Bolts, Nuts & Washers, Structural	453.06B	K. Frame	4153.06	Per IM 453.06B	DME	Mill Certification/Rotational Capacity Test/Test Report per IM 453.06B	Project
Calcium Chloride Solution	373	S. Sommers	4194.01	4 lbs. or 1 qt.	RCE	Test by RCE
Caulking Compound		S. Sommers	4192			Visual Approval by RCE
Concrete, Mechanically Stabilized Earth Panels (MSE)	445.03	M. Khoda	2432			Approved Source/Certification Statement/Shop Drawing	Source
Concrete, Modular & Segmental Block (Dry Cast/Wet Cast)	445.04, 445.05	M. Khoda	2419, 2430, 2431			Approved Source/Certification Statement
Concrete, Noise Wall, Precast	445.06	M. Khoda	2436			Approved Source/Certification Statement/Shop Drawing	Source
Concrete, Precast Box Culvert	445.02	M. Khoda	2415			Approved source, Approved Shop Drawing, Fabricator’s trademark, Date of Manufacture, Certified stamp, Certification Statement	Source
Concrete, Prestressed, Precast Units	570	M. Khoda	2407			Approved Source, Fabricator’s trademark, Date of Manufacture, DOT Inspection stamp, Inspection Report/Certification Statement	Source
Concrete Sealer	491.12	T Hanson	4139			Approved Brand Name
Conduit – See Lighting Material
Curing Matls., Burlap		S. Sommers	4104			Visual Approval by RCE
Curing Matls., Clear	405.07	S. Sommers	4105.07			Approved Brand Name
Curing Matls., Dark-colored	437	C. Brakke	4105.06			Approved Source	Source
Curing Matls., Plastic Film		S. Sommers	4106.01			Visual Approval by RCE
Curing Matls., White Pigmented	405	S. Sommers	4105.05	1 qt.		Batch (Lot) Accept	Source

Material	IM	Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification	Other Details
Crash Cushion	455	S. Sommers	2551			Approved Brand Name, Certification Statement if source not clearly marked
Delineators – See Signing Material.
Detectable Warning Panels	411	M. Khoda	4171			Approved Source/Certification Statement
Dowel – See Steel Reinforcement
Drainage Trough, Elastomeric Bridge Joints	494	S. Sommers				Approved Brand Name
Drains, Floor		K. Frame	2406.03, D			Approved Shop Drawing & Inspection Report
Drums, Channelizing	488.02	S. Sommers	4188.02			Approved Brand Name
Epoxy-coated Steel – See Steel Reinforcement
Epoxy Injection Resin	491.19	T. Hanson				Approved Brand Name
Erosion Control, Fertilizer	469.03	M. Serio	4169.03			Bagged: Bag label analysis. Bulk: Blend ticket/sheet		If material is suspect, DME will sample
Erosion Control, Mulch, Hydraulic	469.10	S. Sommers	4169.07			Approved Brand Name
Erosion Control, Mulch, Straw		S. Sommers	4169.07			Weed Free Certification
Erosion Control, Perimeter & Slope Sediment Control Devices- Sediment Logs, Wattles & Filter Socks	469.10	S. Sommers	4169.12			Approved Brand Name
Erosion Control, Seed	469.02	S. Sommers	4169.02			Seed Ticket Printed with Test Data (rural stabilizing) Approved Source, seed mixture report and certification (seed mixes except rural stabilizing)
Erosion Control, Silt Fence Fabric	496.01	S. Sommers	4196.01			Approved Brand Name
Erosion Control, Silt Fence Wire & Posts		S. Sommers				Visual Approval by RCE
Erosion Control, Sod		S. Sommers	4169.06			Visual Approval by RCE
Erosion Control, Sod Stakes		S. Sommers	4169.09			Visual Approval by RCE
Erosion Control, Sticking Agent		S. Sommers	4169.05			Seed Manufacturing Recommendation
Erosion Control, Wire Staples		S. Sommers	4169.10, A			Visual Approval by RCE
Erosion Control Mats	469.10	S. Sommers	4169.10			Approved Brand Name
Expansion Device, Steel		K. Frame	4152.02			Approved Shop Drawing & Inspection Report

Material	IM	Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification	Other Details
Expansion Tube		K. Frame	4191.01, B			Visual Approval by RCE
Fence, Chain Link Fabric	454.10	M. Khoda	4154.03			Approved Source/ Certification Statement
Fence, Chain Link Fittings		M. Khoda	4154.11			Certification Statement
Fence, Chain Link Posts, Braces, & Rails	454.10	M. Khoda	4154.10			Approved Source/ Certification Statement
Fence, Field Fence Fabric	454.10	M. Khoda	4154.02			Certification Statement
Fence, Gate		M. Khoda	4154.12			Certification Statement
Fence, Orange Mesh Safety	488.03	S. Sommers	4188.03			Approved Brand Name
Fence, Silt – See Erosion Control
Fence, Staples		M. Khoda	4154.06			Visual Approval by RCE
Fence, Steel Line Posts and Braces	454.10	M. Khoda	4154.08 & 4154.09			Approved Source/ Certification Statement
Fence, Wood Fence Post	462	J. De Vries	4154.07			Approved Source/Certification of Grade/Certified Treatment Test Report
Fertilizer – See Erosion Control
Fly Ash	491.17	T. Hanson	4108	15 lbs.	DME	Approved Source/ Certification Statement	Project Source	Verification on paving only
Galvanized Items	410.01	K. Frame	4100.07		DME	Test Report per IM 410.01/Certification Statement	Project
GGBFS	491.14	T. Hanon	4108.02		DME	Approved Source/ Certification Statement	Source Project
Grating (Aluminum)		K. Frame	4187.01, A			Approved Shop Drawing & Inspection Report
Grout, Hydraulic Cement	491.13	T. Hanon				Approved Brand Name
Grout, Polymer	491.11	T. Hanon				Approved Brand Name
Guardrail, High Tension Cable	455.01	J. De Vries	2505.03, B			Approved Source/ Certification Statement
Guardrail, Formed Steel Beam and Terminals	455.02	J. De Vries	4155.02			Approved Source
Guardrail, Steel Posts	455.02	J. De Vries	4155.05			Approved Source/ Mill Test Report
Guardrail, Wood Posts	462	J. De Vries	4155.04			Approved Source/Certification of Grade/Certified Treatment Test Report
Iron Castings, Utility Access Covers, etc.	453.04	K. Frame	4149, 4153.04			Certification Statement & Proper Identification Imprint

Material	IM	Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification	Other Details
Iron Castings, Utility Access Adjustment Rings	449.05	K. Frame	4149, 4153.04			Approved Source/Certification Statement
Iron Bridge Rockers		K. Frame	4153.04			Approved Shop Drawing & Inspection Report
Joint Filler, Flexible Foam-Type CF & EF Joints	436.05	S. Sommers	4136.03, B 4136.03, D			Approved Brand Name
Joint Filler, Type E Joint	436.03	S. Sommers	4136.03, A			Approved Brand Name
Joint Filler, Bituminous	436.03	S. Sommers	4136.03, A			Approved Brand Name
Joint Sealer for Concrete Sewer Pipes	491.09	S. Sommers	4149.04,D,2			Approved Brand Name
Joint Sealer, Elastomeric (Neoprene)	436.02	S. Sommers	4136.03			Approved Brand Name
Joint Sealer, Poured	436.01	S. Sommers	4136.02, A			Approved Brand Name
Keyway		K. Frame	4191.01, A			Visual Approval by RCE
Lighting Material, Aluminum Poles	557	K. Frame	4185.02, F			Approved Shop Drawing/Approved Source/Certification Statement/Inspection Report
Lighting Material, Circuit Test		J. De Vries	2523.03, U		Contractor	Test Report (Contractor) Form #820928
Lighting Material, Connectors		S. Sommers	4185.11			Approved Catalog Cut
Lighting Material, Contactors		S. Sommers	4185.05			Approved Catalog Cut
Lighting Material, Control Cabinet		S. Sommers	4185.07			Approved Shop Drawing & Catalog Cut
Lighting Material, Conduit & Fittings, Plastic		S. Sommers	4185.09	4’-Plastic	DME	Test Report	Project
Lighting Material, Conduit & Fittings, Steel	485.10	S. Sommers	4185.09			Approved Source
Lighting Material, Ground Rods & Clamps		S. Sommers	4185.04			Visual
Lighting Material, Handhole, Fiberglass		S. Sommers	4185.08			Approved Catalog Cut
Lighting Material, Handhole and Cover, HDPE		S. Sommers	4185.08			Approved Catalog Cut
Lighting Material, Handholes, Precast	445.01	M. Khoda	4185.08			Approved Source, Fabricator’s trademark, Date of Manufacture, Certified stamp, Certification Statement	Source
Lighting Material, Junction Boxes		S. Sommers	4185.09			Approved Catalog Cut
Lighting Material, Lighting Tower	557	K. Frame	2522.03, E			Approved Shop Drawing/Approved Source/Certification Statement/Inspection Report

Material	IM	Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification	Other Details
Lighting Material, Lowering Device		K. Frame	2522.03, G			Approved Shop Drawing & Inspection Report
Lighting Material, Luminaries		S. Sommers	4185.03			Approved Catalog Cut
Lighting Material, Photoelectric Control		S. Sommers	4185.06			Approved Catalog Cut
Lighting Material, Sealant for Traffic Loop Detectors	491.18	S. Sommers				Approved Brand Name
Lighting Material, Steel Poles	557	K. Frame	4185.02, E			Approved Shop Drawing/Approved Source/Certification Statement/Inspection Report
Lighting Material, Underground Warning Tape		S. Sommers	2523.03, E			Visual Approval by RCE
Lighting Material, Wire & Cable		S. Sommers	4185.11			Approved Catalog Cut & Certification Statement		DME may obtain verification samples
Lighting Material, Fasteners for Poles	453.09	T. Hanson	4185.02, B	1 each type	DME	Test Report & Approved Shop Drawing
Lighting Material, Mastarms	557	K. Frame	4185.02, C			Approved Shop Drawing/Approved Source/Certification Statement/Inspection Report
Lighting Material, Slip Base	557	K. Frame	4185.02, B			Approved Shop Drawing/Approved Source/Certification Statement
Lighting Material, Wood Poles	462	J. De Vries	4185.02, G			Approved Source/Certification Statement
Lighting Material, Transformer Base	557	K. Frame	4185.02, D			Approved Shop Drawing/Approved Source/Certification Statement
Markers (reflective) for Guardrail & Concrete Barrier Rail	486.08	S. Sommers	4186.12			Approved Brand Name
Markers, Raised Pavement	483.07	S. Sommers	2527.02, D,5			Approved Brand Name
Mastarms – See Lighting Materials
Paint, Epoxy Aluminum	482.04	S. Sommers				Approved Brand Name/Certification Statement
Paint, Traffic-VOC-Compliant Solvent-borne	483.03	S. Sommers	4183.02			Approved Brand Name
Paint, Traffic Waterborne	483.03	S. Sommers	4183.03			Approved Brand Name	Subcontr.
Paint, Waterborne Acrylic Finish (Bridge Paint)	482.05	S. Sommers	4182.03			Approved Brand Name/Certification Statement
Paint, Zinc-rich Epoxy	482.02	S. Sommers	4182.02			Approved Brand Name/Certification Statement
Paint, Zinc-silicate Solvent-borne	482.05	S. Sommers	4182.02			Approved Source/Certification Statement
Patch Material, Rapid-set Concrete	491.20	T. Hanson				Approved Source

Material	IM	Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification	Other Details
Piling, Concrete	570	M. Khoda	4166			Approved Source, Fabricator’s trademark, Date of Manufacture, DOT Inspection stamp, Inspection Report/Certification Statement	Source
Piling, Timber	462	J. De Vries	4165	20 cores /shipment	DME	Approved Source/Certification of Grade/Certified Treatment Test Report	Source	Charge number on butt ends
Piling, Steel	467	K. Frame	4167			Approved Source/Mill Certification	Project
Pipe, PVC Sewer	443, 446	S. Sommers	4149.02			Approved Source/Certification Statement	Source
Pipe, Concrete Special Sections	445.01	M. Khoda	2419, 4145 4149.02, B			Approved Source, Fabricator’s trademark, Date of Manufacture, Certified stamp, Certification Statement	Source
Pipe, Corrugated Aluminized	441	M. Khoda	4141			Approved Source/Certification Statement
Pipe, Corrugated Polyethylene 3-10 in.	443	S. Sommers	4146.02 4143.01			Approved Source	Source
Pipe, Corrugated Polyethylene 12-36 in.	446	S. Sommers	4146.02			Approved Source/Certification Statement	Source
Pipe, Corrugated Steel	441	M. Khoda	4141			Approved Source/Certification Statement	Fabricator
Pipe, Ductile Iron Sewer		M. Khoda	4149.02			Certification Statement
Pipe, Polyethylene Sewer	443, 446	S. Sommers	4146.03			Approved Source/Certification Statement	Source
Pipe, Concrete Subdrain Tile	448	S. Sommers	4148			Approved Source/Certification Statement	Source
Pipe, Corrugated Metal Subdrain Outlet	441	M. Khoda	4143.01, B			Approved Source/Certification Statement	Fabricator
Pipe, Corrugated Polyethylene Subdrain	443	S. Sommers	4143.01, B			Approved Source	Source
Pipe, Welded Steel for Bridge Rail (See Railing, Bridge)		K. Frame
Pipe, Horizontal Subdrain	443	S. Sommers	4143.01, A			Approved Source	Source
Plant Material, Fertilizer	469.03	S. Sommers	4170.09, B			Bagged: Bag label analysis. Bulk: Blend ticket/sheet		If material is suspect, DME will sample
Plant Material, Mulch	470	S. Sommers	4170.09, D		RCE	Field Review Report
Plant Materials, Plants	470	S. Sommers	4170.01-4170.08		Roadside Development	Field Review Report		Rpt. Issued-Roadside Development
Portland Cement Concrete Premix Pack	447	T. Hanson				Approved Source/Certification Statement	Source

Material	IM	Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification	Other Details
Portland Cement, All Types	401	T. Hanson	4101	10 lbs.	DME	Approved Source/Certification Statement	Project Source
Railing, Bridge		K. Frame	4153.05			Approved Source/Approved Shop Drawing/ Inspection Report
Reflective Sheeting – See Signing Material
Reflectorized spheres / elements	484	S. Sommers	4184
Release Agent	491.15	C. Brakke	491.15			Approved Brand Name
Sealant, Traffic Loop – See Lighting Material
Seed – See Erosion Control
Signing Material, Delineators, Prismatic Reflectors	486.07	S. Sommers	4186.11			Approved Brand Name
Signing Material, Finished Sign	486	S. Sommers	4186			Shipping Report/Approved Source/Certification Statement	Source
Signing Material, Fasteners		S. Sommers	4186.09			Inspection Report
Signing Material, Post, Delineator	486.10	J. De Vries	4186.10, C			Certification Statement
Signing Material, Post, Perforated square steel tube	486.10	J. De Vries	4186.10			Approved Source/Certification Statement
Signing Material, Reflective	486.03	S. Sommers	4186.03			Approved Brand Name	Source
Signing Material, Sign Panels		S. Sommers	4186.02			Approved Shop Drawing & Shipping Report
Signing Material, Sign Support Structures	557	K. Frame	4187			Approved Source/Approved Shop Drawing/ Inspection Report/Mill Certification
Signing Material, Stainless Steel Fasteners	453.07	K. Frame				Approved Source/Mill Certification	Project
Sod – See Erosion Control
Steel Castings		K. Frame	4153.03			Approved Source/Catalog Cut
Steel Masonry Plates		K. Frame	4152.02			Mill Certification
Steel Pipe, Welded		K. Frame	4153.05			Approved Shop Drawing & Inspection Report
Steel, Pins/Rollers, Cold Finished		K. Frame	4153.02			Approved Source/Catalog Cut
Steel, Pins/Rollers, Forged		K. Frame	4153.01			Approved Source/Catalog Cut
Steel Reinforcement, Basket Assemblies	451.03B	M. Khoda	4151.02			Approved Source/Certification Statement

Material	IM	Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification	Other Details
Steel Reinforcement, Epoxy-coated	451.03B	M. Khoda	4151.03, C	6 ft.	DME	Approved Source/Mill Certifications & Epoxy Certification Statement /Test Report	Project	Test sample should be 3 ft. away from end of the bar. For Bridge decks, obtain a random sample. For projects other than bridge decks, sample when project quantity >= 5 tons
Steel Reinforcement, Epoxy-coated Tie Bars	451.03B	M. Khoda	4151.02, A	1 bar	DME	Approved Source/Certification Statement	Project	1 per source per year
Steel Reinforcement, Galvanized	451	M. Khoda	4151.03, B	3 ft.	DME	Mill Certifications & Test Report for Galvanizing	Project
Steel Reinforcement, Stainless	452	M. Khoda	4151	6 ft.	DME	Approved Source/Mill Certification	Project	Sample when project quantity >=1ton.
Steel Reinforcement, Uncoated	451	M. Khoda	4151	*6 ft. of most common	DME	Approved Source/Mill Certification	Project	Sample when project quantity >=45ton.
Steel Reinforcement, Wire Mesh	451	M. Khoda	4151.04
Steel Mechanical Splicers for Reinforcement	451	M. Khoda			DME	Approved Source/Mill Certification/Epoxy Certification	Project	Need: Certification Statement, Project #, Quantity, Heat #
Steel Structural, Main Members (Except Bearing Devices)	557, 561 to 565	K. Frame	2408 & 4152			Approved Source/Approved Shop Drawing/Fabrication Report/Mill Certifications
Steel Structural, Bridge Components	557, 561 to 565	K. Frame	2408 & 4152			Approved Source/Approved Shop Drawing/Inspection Report/Mill Certifications
Steel Structural, Engineered Truss Trail Bridge	557, 561 to 565	K. Frame	2408 & 4152			Approved Source/Approved Shop Drawing
Step Irons for Utility Access		M. Khoda	4149.04, L			Inspection Report
Structural Items, Other		K. Frame				Approved Shop Drawing & Inspection Report
Structural Plate (Arches)	444	M. Khoda	4144	Visual	RCE	Approved Source/Certification Statement
Studs, Shear	453.10	K. Frame				Approved Source/ Mill Certification
Tape, Pavement Marking	483.06	S. Sommers	2527.02, D			Approved Source
Torque Calibration Machine (Skidmore)		K. Frame	2408.03, S	Verified every 12 mo.	CTRL	Approved Brand Name
Torque Wrench		K. Frame	2408.03, S	Verified every 12 mo.	CTRL	Test Report

Material	IM	Contact	Spec.	Sample Size	Sampled By	Basis of Acceptance	Verification	Other Details
Utility Access Adjustment Rings	449.05	K. Frame	4149.04			Approved Source/Certification Statement
Traffic Signalization, Electrical Tests		J. De Vries	2525.03, E 2525.03, H		Contractor	Test Report (Contractor) Form #820928
Wire & Cable – See Lighting Material		S. Sommers	4150.02			Catalog Cut/ Manufacturer Certification of Buy America IM 107
Watermain, Fire Hydrant Assembly		S. Sommers	4150.04			Catalog Cut/ Manufacturer Certification of Buy America IM 107
Watermain, PVC Pipe	446	S. Sommers	4150.02			Catalog Cut
Watermain, PVC Pipe Fittings	446	S. Sommers	4150.02			Catalog Cut
Watermain, Valves		S. Sommers	4150.03			Catalog Cut/Manufacturer Certification of Buy America IM 107
Wood, Hardware for Timber Structure	462	S. Sommers	4153.07	1 ea. type		Test Report
Wood, Treated Posts	462	J. De Vries	4164			Approved Source/Certification of Grade/Certified Treatment Test Report
Wood, Treated Timber & Lumber	462	J. De Vries	4163			Approved Source/Certification of Grade/Certified Treatment Test Report
Wood, Untreated Timber & Lumber	462	J. De Vries	4162	Visual	RCE	Quality grad mark or certification of grade on items requiring grade
NOTE: For Local agency projects with no Federal funding, verification samples or monitor samples sampled by the DME are not required. These samples may be sampled by the contracting authority. With prior approval, these samples may be tested by the Iowa Department of Transportation Central Laboratory.

Sampling & Testing Guide-Minimum Frequency

SUPPLEMENTAL GUIDE – BASIS OF ACCEPTANCE

Matls. IM 204

Appendix Z