North Carolina Department of Transportation

Materials and Tests Unit

Research & Investigations Section

PIPE INSPECTION REQUEST FORM

Date Request Made
Date Requested for Inspection
Date Project Completion (Estimated)
Request By (Name)
Title
Telephone Numbers Office: Cell:
Project Contact (Name)
Project Contact Telephone Numbers Office: Cell:
County - Division
Contract Number
Pipe Location
Location to Meet for Pipe Inspection
Number of Lines to be inspected
Pipe Number Length of Pipe Pipe Diameter Type (RCP, Reason Pipe Inspection Requested for Each Line
(ft. or m) (inch or mm) CMP, Etc.) (Quality Control, 10% Project, Incidental, Etc.)
1

10
If you have questions about this form, please contact Randy Pace @ (919) 329 4220, or rpace@ncdot.gov

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Research and Investigations – Materials and Tests Unit

 North Carolina Department of Transportation
Materials and Tests Unit
Research & Investigations Section

PIPE INSPECTION REQUEST FORM

Date Request Made
Contract Number
Pipe Number Length of Pipe Pipe Diameter Type (RCP, Reason Pipe Inspection Requested for Each Line
(ft. or m) (inch or mm) CMP, Etc.) (Quality Control, 10% Project, Incidental, Etc.)
11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

Notes and
Comments:

Research and Investigations – Materials and Tests Unit

If you have questions about this form, please contact Randy Pace @ (919) 329 4220, or rpace@ncdot.gov