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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"STRUCTURAL"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"REHABILITATION"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CHECKLIST"]
[]
[null,null,"Bridge No.:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Job No.:"]
[]
[null,null,"Route:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Over:"]
[]
[null,null,"County:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date of Field Check:"]
[]
["* * * Please include photographs for all items that apply. * * *"]
[]
[]
["1"]
[null,"OVERLAY"]
[]
[null,null,"*","Type of existing overlay:",null,null,null,null,null,null,null,null,null,null,null,"None",null,null,null,null,"Asphalt",null,null,null,null,"Low Slump",null,null,null,null,null,null,"Silica Fume",null,null,null,null,null,"Latex",null,null,null,null,"Epoxy ",null,null,null,"Other:"]
[]
[null,null,"*","Existing overlay thickness:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\"",null,null,null,null,null,null,"*","Year overlay was applied:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Unknown"]
[]
[null,null,"*","% of overlay repaired or patched:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"%",null,null,null,null,"*","Replace overlay:",null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No"]
[null,null,null,null,null,null," "]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["2A"]
[null,"DECK REPAIRS",null,null,null,null,null,null,null,"(Deck repair quantities are required even if a Deck Test request has been ordered for this structure.)"]
[]
[null,null,"*","Half-sole repairs:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,null,null,"*","Full depth repairs:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"sq. ft."]
[null,null,null,null,"(round up to the nearest 50 sq. ft.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(round up to the nearest 50 sq. ft.)"]
[]
[null,null,"*","Existing deck repair (patching):",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"sq. ft."]
[null,null,null,null,"(round up to the nearest 25 sq. ft.)"]
[]
[null,null,"*","Slab edge repairs:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"lin. ft.",null,null,null,null,null,null,"*","Superstructure repair (Unformed):",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"sq. ft."]
[null,null,null,null,"(covers the outer 4\" of the slab edge)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(covers the remaining slab cantilever beyond the outer 4\")"]
[]
[null,null,"*","Clean & epoxy coat slab edge:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"lin. ft.",null,null,null,null,null,null,"*","Cantilever replacement:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"lin. ft."]
[null,null,null,null,"(in lieu of edge repairs)"]
[]
[null,null,"*","Total surface hydro demolition of bridge deck:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,"No",null,"*","Full deck replacement (redeck):",null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,"Optional"]
[null,null,null,null,"(half-sole, full depth and exist. deck repair quantities still required)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"*","Superstructure replacement:",null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,"Optional"]
[null,null,"*","Deck repairs with voided tube replacement:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,"No"]
[null,null,null,null,"(minimum of 10% of half-sole repair quantity)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"*","Full bridge replacement:",null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,"Optional"]
[null,null,null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(Deck repair quantities required for cost comparison of alternatives)"]
[]
[null,null,"*","How were the quantities obtained?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Visual",null,null,null,null,"Bridge Inspection Report",null,null,null,null,null,null,null,null,null,null,"Sounded",null,null,null,null,"Other"]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["2B"]
[null,"DECK REPAIRS CONT."]
[]
[null,null,"* ISSUES / PROBLEMS WITH PRECAST PRESTRESSED DECK PANELS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,null,"Spans",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Location in Span",null,null,null,null,null,null,null,null,null,null,null,"Deterioration",null,null,null,null,null,null,null,null,null,"Describe"]
[null,null,null,null,null,null,null,null,null,"At ",null,null,null,null,"Btwn (mid)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Type ",null,null,null,null,null,"Amount"]
[null,null,null,null,null,null,null,null,"Panel Jt.",null,null,null,null,"Panel Jt.",null,null,null,null,"End",null,null,null,"Mid",null,null,null,"End"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,"sq. ft."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null," "," ",null,null,"sq. ft."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null," "," ",null,null,"sq. ft."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null," "," ",null,null,"sq. ft."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null," "," ",null,null,"sq. ft."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null," "," ",null,null,"sq. ft."]
[]
[null,null,"*","Notes:"]
[]
[]
[]
[null,null,"(Deterioration may include water saturation, efflorescence, rust staining, cracking, spalling, exposed steel, disintegration of panel edges"]
[null,null,"at joints, etc.  Typically observed at or near panel joints. The location and \"Type\" of deterioration should be recorded.)"]
[]
["Picture #"]
[]
[]
[]
["3"]
[null,"APPROACH SLABS"]
[]
[null,null,"*","Is there a bridge approach slab in place?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,"*","Type:",null,null,null,null,"Concrete",null,null,null,null,"Asphalt",null,null,null,null,"Other"]
[]
[null,null,"*","Is there rdwy. approach pavement in place?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,"*","Type:",null,null,null,null,"Concrete",null,null,null,null,"Asphalt",null,null,null,null,"Other"]
[]
[null,null,"*","Is the approach slab sinking at the end bent?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N/A",null,null,null,"Yes",null,null,null,"No"]
[]
[null,null,"*","Are repairs needed to the bridge approach slab driving surface?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No"]
[null,null,null,"(Typically a roadway item but will be reported to District on the Bridge Memorandum.)"]
[]
[null,null,"*","Full replacement of bridge approach slab?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No"]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["4"]
[null,"SLAB DRAINS"]
[]
[null,null,"*","Is the drainage system working adequately?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No"]
[]
[]
[null,null,"*","Recommendations:"]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["5"]
[null,"CURBS & RAILS"]
[]
[null,null,"*","Existing curb (left side):",null,null,null,null,null,null,null,null,null,null,"Safety Barrier Curb",null,null,null,null,null,null,null,null,"Curb/parapet",null,null,null,null,null,null,"Blockouts",null,null,null,null,null,"Thrie Beam",null,null,null,null,null,null,"Baluster",null,null,null,null,"Steel Channel"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Other",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Handrail",null,null,null,null,null,"Fence"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"*","Does curb need repair",null,null,null,null,null,null,null,null,"Yes",null,null,"No",null,null,null,"*   Curb repair",null,null,null,null,null,null,null,null,null,"lin. ft."]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"*","Remove hand rail",null,null,null,null,null,null,null,null,"Yes",null,null,"No",null,null,null,"*","Add curb blockout",null,null,null,null,null,null,null,"Yes",null,null,null,"No"]
[]
[null,null,"*","Existing curb (right side):",null,null,null,null,null,null,null,null,null,null,"Safety Barrier Curb",null,null,null,null,null,null,null,null,"Curb/parapet",null,null,null,null,null,null,"Blockouts",null,null,null,null,null,"Thrie Beam",null,null,null,null,null,null,"Baluster",null,null,null,null,"Steel Channel"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Other",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Handrail",null,null,null,null,null,"Fence"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"*","Does curb need repair",null,null,null,null,null,null,null,null,"Yes",null,null,"No",null,null,null,"*   Curb repair",null,null,null,null,null,null,null,null,null,"lin. ft."]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"*","Remove hand rail",null,null,null,null,null,null,null,null,"Yes",null,null,"No",null,null,null,"*","Add curb blockout",null,null,null,null,null,null,null,"Yes",null,null,null,"No"]
[]
[null,null,"*","Existing median curb:",null,null,null,null,null,null,null,null,null,"Type:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Width",null,null,null,null,null,null,"\"",null,"Height",null,null,null,null,null,null,"\""]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"*","Does curb need repair",null,null,null,null,null,null,null,null,"Yes",null,null,"No",null,null,null,"*   Curb repair",null,null,null,null,null,null,null,null,null,"lin. ft."]
[]
[null,null,"*","Approach rail attachment:",null,null,null,null,null,null,null,null,null,null,null,null,"None",null,null,null,null,"Not attached",null,null,null,null,null,null,"4 Hole",null,null,null,null,"5 Hole",null,null,null,null,"Turn-down",null,null,null,null,null,"Other"]
[]
[]
[null,null,"*","If the existing handrails will be removed, does the local maintenance supervisor wish to keep them?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No"]
[]
[null,null,null,null,"Storage address:",null,null,null,null,null,null,"location:"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"address:"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"city:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"state:",null,null,null,null,null,null,"zip:"]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
["6"]
[null,null,"EXPANSION DEVICES"]
[]
[null,null,"Bent",null,null,null,"Type",null,null,null,null,null,null,null,null,null,null,"Recommendations",null,null,null,null,null,null,null,null,null,"Gap Left",null,null,null,null,null,null,"Gap Right",null,null,null,null,null,null,"Temperature & Other Info"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"USE-IN-PLACE",null,null,"REPAIR",null,null,"REPLACE",null,null,null,null,null,null,null,"\"",null,null,null,null,null,null,"\""]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\"",null,null,null,null,null,null,"\""]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\"",null,null,null,null,null,null,"\""]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\"",null,null,null,null,null,null,"\""]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\"",null,null,null,null,null,null,"\""]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\"",null,null,null,null,null,null,"\""]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
["7"]
[null,"BEARINGS"]
[]
[null,null,"Bent",null,null,null,null,null,"Coating",null,null,null,null,null,null,null,null,"Recommendations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Notes (indicate which bearings at each bent)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MAKE END BENT SLIDING SLAB"]
[null,null,null,null,null,null,null,null,"CLEAN & OVERCOAT",null,null,"BLAST CLEAN & RECOAT",null,null,null,null,"USE-IN-PLACE",null,null,"REPAIR",null,null,"RESET",null,null,"REPLACE",null,null,null,null,null,"MAKE END BENT INTEGRAL",null," "]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture # (Provide Pictures of Each Bearing)"]
[]
[]
["8"]
[null,"COATING SYSTEM (PAINT)"]
[]
[null,null,"*","Existing coating system:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"green",null,null,null,"gray",null,null,null,"other"]
[]
[]
[null,null,"*","Date last coated:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"*","Is existing coating peeling?",null,null,null,null,null,null,null,null,null,null,null,"Yes (Overcoat is not an option)",null,null,null,null,null,null,null,null,null,null,null,null,"No"]
[]
[null,null,"*","Coating recommendation:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Blast clean & recoat all steel",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Clean & overcoat all steel"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Blast clean & recoat only at joint locations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Blast & recoat at joint locations  and clean & overcoat all other steel"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Note: Pull-off test required for overcoat (Calcium Sulfonate) option.  Bridge Division will request pull-off tests."]
[]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["9"]
[null,"SUPERSTRUCTURE REPAIRS",null,null,null,null,null,null,null,null,null,null,null,null,null,"(Repairs needed not previously stated.)"]
[]
[null,null,"Concrete Slab Superstructure or Girder:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(above the bearings)"]
[null,null,"(Example: Deck solid slabs, voided slabs, box girders,"]
[null,null,"deck girders & prestressed girders)"]
[]
[]
[null,null,"Steel:",null,null,"(Example: Beams, stringers, girders, diaphragms, cross-frames, misc. steel)"]
[null,null,"Member ",null,null,null,"(Check all that apply) (Attach pictures)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Describe & Locate"]
[null,null,null,null,null,null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,"Section Loss",null,null,null,null,null,null,null,null,"%",null,null,null,"Cracks ",null,null,null,null,null,null,"in."]
[null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,"Section Loss",null,null,null,null,null,null,null,null,"%",null,null,null,"Cracks ",null,null,null,null,null,null,"in."]
[]
[null,null,null,null,null,null,null,null,null,null,null,"Section Loss",null,null,null,null,null,null,null,null,"%",null,null,null,"Cracks ",null,null,null,null,null,null,"in."]
[]
[null,null,null,null,null,null,null,null,null,null,null,"Section Loss",null,null,null,null,null,null,null,null,"%",null,null,null,"Cracks ",null,null,null,null,null,null,"in."]
[]
[null,null,null,"Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["10"]
[null,"SUBSTRUCTURE REPAIR"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Seal Concrete",null,null,null,null,null,null,"Coat Exposed Pile"]
[null,null,"Bent",null,null,null,"Formed Repair",null,null,null,null,null,null,null,"Unformed Repair",null,null,null,null,null,null,null,"Beam Cap Bts.",null,null,null,null,null,null,"@ Int. Pile Cap Bts.",null,null,null,null,null,null,null,null,"Describe (Beam, Backwall, Wing, etc.)"]
[]
[null,null,null,null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,"Yes",null,null,"No",null,null,null,null,"Yes",null,null,"No"]
[]
[null,null,null,null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,"Yes",null,null,"No",null,null,null,null,"Yes",null,null,"No"]
[]
[null,null,null,null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,"Yes",null,null,"No",null,null,null,null,"Yes",null,null,"No"]
[]
[null,null,null,null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,"Yes",null,null,"No",null,null,null,null,"Yes",null,null,"No"]
[]
[null,null,null,null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,null,null,null,"sq. ft.",null,null,null,null,"Yes",null,null,"No",null,null,null,null,"Yes",null,null,"No"]
[]
[null,null,"*","Does the structure need graffiti protection?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No",null,null,null,"Bottom 8' of Concrete",null,null,null,null,null,null,null,null,null,"End Bents",null,null,null,null,null,null,"Other"]
[]
[null,null,"*","Notes:"]
[]
["Picture #"]
[]
[]
[]
["11"]
[null,"SIGNS, SIGNALS &/OR LIGHTING ATTACHED TO STRUCTURE"]
[]
[null,null,"*","Are there signs attached directly to this structure?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,"quantity",null,null,null,null,null,null,"location"]
[]
[null,null,"*","Describe proposed work to be done to signs."]
[]
[]
[null,null,"*","Are there signals attached directly to this structure?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,"quantity",null,null,null,null,null,null,"location"]
[]
[null,null,"*","Describe proposed work to be done to signals."]
[]
[]
[null,null,"*","Is there aviation lighting attached to this structure?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,null,"N/A",null,null,null,"Red",null,null,null,null,null,null,"Green"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"qnty.",null,null,null,null,null,null,null,"qnty."]
[null,null,"*","Is there navigational lighting attached to this structure?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,null,"N/A",null,null,null,"Red",null,null,null,null,null,null,"Green"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"qnty.",null,null,null,null,null,null,null,"qnty."]
[null,null,"*","Is there roadway lighting attached to this structure?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,null,"N/A"]
[]
[null,null,"*","Describe proposed work to be done to lighting."]
[]
[]
[]
[null,null,"*","Notes:"]
[]
[]
["Picture #"]
[]
[]
[]
["12"]
[null,"UTILITIES ATTACHED TO STRUCTURE"]
[]
[null,null,null,null,null,null,null,null,"Type",null,null,null,null,null,null,null,"Qty.",null,null,null,"Size",null,null,null,null,null,null,null,null,"Owner",null,null,null,null,null,"Condition"]
[]
[null,null,null,"Conduit",null,null,null,null,"Pipeline",null,null,null,null,"Other",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Repaint",null,null,null,null,"Repair",null,null,null,"Replace",null,null,null,null,"Remove"]
[]
[null,null,null,"Conduit",null,null,null,null,"Pipeline",null,null,null,null,"Other",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Repaint",null,null,null,null,"Repair",null,null,null,"Replace",null,null,null,null,"Remove"]
[]
[null,null,null,"Conduit",null,null,null,null,"Pipeline",null,null,null,null,"Other",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Repaint",null,null,null,null,"Repair",null,null,null,"Replace",null,null,null,null,"Remove"]
[]
[null,null,null,"Conduit",null,null,null,null,"Pipeline",null,null,null,null,"Other",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Repaint",null,null,null,null,"Repair",null,null,null,"Replace",null,null,null,null,"Remove"]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["13"]
[null,"CATHODIC PROTECTION SYSTEM"]
[]
[null,null,"*","Is there a cathodic system on this structure?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,null,"Remove",null,null,null,null,"Do not alter",null,null,null,null,null,"Abandon in place (grooved system)"]
[]
[null,null,"*","Is it on and working?",null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,null,"Unknown"]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["14"]
[null,"CHANNEL ALIGNMENT, SLOPE PROTECTION & SCOUR"]
[]
[null,null,"*","Is channel aligned to bridge opening?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,"Describe"]
[]
[null,null,"*","Is drift a continual problem?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,null,null,null,null,null,"Describe & Locate"]
[]
[null,null,"*","Is erosion a problem?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,null,null,null,null,null,"Describe & Locate"]
[]
[null,null,"*","Describe slope protection in place."]
[]
[null,null,"*","Scour",null,null,null,null,"At Footing",null,null,null,null,null,null,"At Piling",null,null,null,null,null,null,"Depth",null,null,null,null,null,null,null,null,"Bent",null,null,null,null,null,null,"Recommendation"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[]
[null,null,"*","Describe needed work."]
[]
[]
[]
[]
[]
["Picture #"]
[]
[]
[]
["15"]
[null,"TRAFFIC LANES"]
[]
[null,null,"*","Number of lanes striped:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"on structure",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"under structure"]
[]
[]
[null,null,"*","Shoulder width:",null,null,null,null,null,null,null,null,null,"None",null,null,null,null,null,null,null,"on structure",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"under structure"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(left)",null,null,null,null,"(right)",null,null,null,null,null,null,null,null,null,null,"(left)",null,null,null,null,"(right)"]
[]
[null,null,"*","Sidewalk widths:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"on structure",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"under structure"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(left)",null,null,null,null,"(right)",null,null,null,null,null,null,null,null,null,null,"(left)",null,null,null,null,"(right)"]
[]
[null,null,"*","Median width:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"on structure",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"under structure"]
[]
[]
[null,null,"*","Proposed improvements for lanes/shoulders/sidewalks:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["16"]
[null,"GENERAL AREA CONDITIONS"]
[]
[null,null,"*","Primary area:",null,null,null,null,null,null,null,"Commercial",null,null,null,null,null,null,"Industrial",null,null,null,null,null,null,"Residential",null,null,null,null,null,null,"Agricultural",null,null,null,null,null,null,"Military",null,null,null,null,"Other"]
[]
[]
[null,null,"*","Posted speed limit on structure:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"mph"]
[]
[]
[null,null,"*","Posted load on structure:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"tons",null,null,"@",null,null,null,null,null,"mph",null,null,null,"NA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"*","Are both signs in place?"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Single Unit:",null,null,null,null,null,"tons",null,null,"@",null,null,null,null,null,"mph",null,null,null,"NA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Semi (tractor/trailer):",null,null,null,null,null,"tons",null,null,"@",null,null,null,null,null,"mph",null,null,null,"NA"]
[]
[]
[null,null,"*","Do pedestrians and/or bicyclists regularly use this structure?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Yes",null,null,null,"No",null,null,null,"Undetermined"]
[]
[]
[null,null,"*","Notes:"]
[]
[]
[]
["Picture #"]
[]
[]
[]
["17"]
[null,"MAINTENANCE"]
[]
[null,null,"*","What work has been done to this structure that may not be reflected on existing bridge plans?"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["Picture #"]
[]
[]
[]
["18"]
[null,"ADDITIONAL FIELD NOTES"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["Picture #"]
[]
[]
[]
["19"]
[null,"STAGING / DETOUR"]
[]
[null,null,"*","Traffic Control:",null,null,null,null,null,null,null,"Close structure",null,null,null,null,null,null,null,"Stage construction on structure",null,null,null,null,null,null,null,null,null,null,null,null,"Cross over traffic to adjacent structure",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Detour"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"Other option"]
[]
[]
[null,null,"*","Define probable detour route."]
[]
[]
[]
[]
[]
[]
[]
[]
["20"]
[null,"PERSONS ASSISTING WITH CHECKLIST"]
[]
[null,null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Title",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ph.",null,"(",null,null,")",null,null,null,"-"]
[]
[null,null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Title",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ph.",null,"(",null,null,")",null,null,null,"-"]
[]
[null,null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Title",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ph.",null,"(",null,null,")",null,null,null,"-"]
[]
[null,null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Title",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ph.",null,"(",null,null,")",null,null,null,"-"]
[]
[null,null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Title",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ph.",null,"(",null,null,")",null,null,null,"-"]
[]
[]
[]
["21"]
[null,"REQUIRED SIGNATURES"]
[null,null,null,null,null,"I have reviewed the information on this checklist and believe it to be as accurate as possible."]
[]
[]
[]
[null,null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[null,null,null,null,null,"Transportation Project Manager"]
[]
[null,null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[null,null,null,null,null,"District Bridge Engineer"]
[]
[]
["The structural rehabilitation checklist indicates how the bridge is functioning and aging."]
[]
["All deterioration should be noted, even if it is known that the work will not be completed under the proposed project."]
[]
["Send NEW Structural Rehabilitation Checklist by email"]
["To: \"Bridge Survey Processor\""]
["Cc: Structural Project Manager or Structural Resource Manager"]