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[]
[null,null,null,"REQUEST FOR CONDUCTING OF"]
[null,null,null,"SURFACE SMOOTHNESS, FRICTION RESISTANCE (SKID)"]
[null,null,null,"FALLING WEIGHT DEFLECTOMETER (FWD) OR CORES"]
[]
[null,"Authorization Number:"]
[null,"State Project Number:"]
[null,"Federal Project Number:"]
[null,"County:"]
[null,"District:"]
[null,"Project Name:"]
[]
[null,"English or Metric:"]
[null,"Project Length:"]
[null,"Asphalt or Concrete:"]
[null,"Total Thickness:"]
[null,"Lot Sampling Size:"]
[null,"Completion Date:"]
[]
[null,"Contractor:"]
[null,"Plant:"]
[null,"T 400#:"]
[]
[null,"Project info:"]
[null,"(Speed, # lanes, etc)"]
[]
[]
[null,"Testing Required:",null,null,"Smoothness",null,null,"FWD"]
[null,null,null,null,null,null,null,"Bridge "]
[null,null,null,null,"Friction",null,null,"Deck"]
[]
[null,"Requested Inspection Date:"]
[]
[null,null,null,null,"Names",null,null,"Phone:"]
[null,"Project Supervisor:"]
[null,"Contact Person:"]
[]
[null,"Direction to Site:"]
[]
[]
[null,"Specifications:"]
[]
[null,"Please fax or Mail"]
[null,"the Following Items:",null,null,"Location Map"]
[]
[null,"Fax Number",null,null,"304 558-0253"]
[null,"Address:",null,null,"190 Dry Branch Drive"]
[null,null,null,null,"Charleston, WV  25306"]
[]
[null,null,"For:",null,"Email this form to:"]
[null,null,"Smoothness",null,"Christopher.G.Preston@wv.gov"]
[null,null,"FWD",null,"Clifford.J.Skeens@wv.gov"]
[null,null,"Bridge Deck",null,"Clifford.J.Skeens@wv.gov"]
[null,null,"Friction",null,"Steve.O.Marshall@wv.gov"]
[]
[null,"Please send a copy to:",null,null,"Roy.J.Capper@wv.gov"]

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