Project Description

Project No.: Enter project #

Project Name: Enter project name

Project Limits

Route
Parish
Control Section
Beg. Log Mile
End Log Mile
Pavement Type

Description of Work: Enter project location and description. Use shift+enter to start a new paragraph.

Provide supporting documentation/exhibits with the request. Exhibits and additional documentation may include existing pavement lab data, asbuilts, correspondence from other sections, site photos, statements from personnel with knowledge of site history, etc.

General Information

Provide the PMS recommended treatment and the distresses that triggered the recommend treatment.

Provide description.

Provide the proposed treatment and describe why the proposed treatment will adequately address the distresses identified by PMS data.

Provide description.

Required Signatures

Recommended by: Design Engineer Please Print	Date:
Signature:

Recommended by: Lab Engineer Please Print	Date:
Signature:
Recommended by: Project Engineer Please Print	Date:
Signature:
Recommended by: Area Engineer Please Print	Date:
Signature:
Recommended by: ADA of Engineering Please Print	Date:
Signature:
Approved by: Program Manager Please Print	Date:
Signature: