****THIS IS A NEW APPENDIX. – PLEASE READ CAREFULLY.****

IOWA DEPARTMENT OF TRANSPORTATION

HIGHWAY DIVISION – MATERIALS

FABRICATION INSPECTION SHIPMENT RELEASE

FABRICATOR:________________________________________________________________

PROJECT NUMBER:_________________________________COUNTY:_________________

DESIGN NUMBER:____________________________________________________________

Fabricator Job Number	Item Description / Remarks		Quantity
The material items described above is released for use subject to dimensional conformance, material grade, fit of connections, and acceptance at the project site when the Iowa DOT stamp has been affixed to this document.		Iowa DOT Stamp _____________________________ Inspector Signature Date