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Local Assistance Procedures Manual EXHIBIT 16-W <br />Source Inspection Request to TransLab <br />SAMPLE COVER MEMO <br />SOURCE INSPECTION REQUEST <br />FROM LOCAL AGENCY'S RESIDENT ENGINEER TO CALTRANS' OFFICE OF MATERIALS <br />ENGINEERING AND TESTING SERVICES <br />(Prepared by Applicant on Applicant Letterhead) <br />To: Office of Materials Engineering & Testing Date: <br />Services, MS #5 <br />California Department of Transportation <br />5900 Folsom Blvd. <br />Sacramento, CA 95819 <br />EA: <br />ProjectNumber: <br />Project Description: <br />Subject: ( Source Inspection for Project Name, County <br />We are requesting that Caltrans provide Source Inspection (reimbursed) services for the above -mentioned <br />project. We requested and received prior authorization for this service from our district Local Assistance <br />Engineer, as noted by the attached approval memo from District Local Assistance Engineer. <br />Please find the following documents enclosed as required: <br />1. Completed CEM-3101 <br />2. One set of PS&E <br />Any question you might have about the materials, to be inspected, should be directed <br />to: , at (phone #) <br />(Applicant Representative Name) <br />(Title) <br />(Local agency, name & address) <br />Page 16-111 <br />LPP 05-03 November 23, 2005 <br />