Submit completed form to Regional Bridge Engineer before opening road to traffic.	Project Engineer:	Telephone #:
To fill in form: Click on text boxes and enter applicable clearances.	Recorded By:	Date:
Cardinal Direction:
Project ID:	Contract:	Region:
Highway: over/under	County:	Structure Number:
Contractor:	Supervisor:

Project Label (Optional)

LOOKING Vertical Clearance

Vertical Clearance Vertical Clearance

LOOKING