North Carolina Department of Transportation MT 100-Lab

(ldp) Rev111/1/14
Materials and Tests Unit
REQUISITION FOR SUPPLIES ( LAB USE ONLY )
FAX (1) COMPLETED COPY TO M&T STOCKROOM (919-733-8742)
8" Full-Height 37 ea # 200 # Req Fill UI Gilson TS1 Shaker
# Req Fill UI Size 38 ea P-Skt 74 ea No. 16 Cloth
1 ea # 4 39 ea Pan 75 ea No. 10 Cloth
2 ea # 8 12" Intermediate-Height 76 ea No. 8 Cloth
3 ea # 10 40 ea # 4 77 ea No. 4 Screen
4 ea # 12 41 ea # 8 78 ea 1/4" Screen
5 ea # 16 42 ea # 16 79 ea 3/8" Screen
6 ea # 18 43 ea # 30 80 ea 1/2" Screen
7 ea # 20 44 ea # 50 81 ea 3/4" Screen
8 ea # 25 45 ea # 100 82 ea 1" Screen
9 ea # 30 46 ea # 200 83 ea 1-1/4" Screen
10 ea # 35 47 ea 3/8" 84 ea 1-1/2" Screen
11 ea # 40 48 ea 1/2" 85 ea 2" Screen
12 ea # 50 49 ea 3/4" 86 ea Tray w/Hooks (For Cloths)
13 ea # 60 50 ea 1" 87 ea Tray w/out Hooks (For Screens)
14 ea # 80 51 ea Pan 88 ea Door Assembly
15 ea # 100 12" Full-Height 89 ea Dust Pan
16 ea # 140 52 ea # 4 90 gal Hydraulic Pump Oil (Reservoir)
17 ea # 200 53 ea # 8 # Req Fill UI Lab Supplies
18 ea # 230 54 ea # 10 91 btl Aggregate / Asphalt Rice Water
19 ea # 270 55 ea # 12 92 ea Atomizer-Humidity Room
20 ea # 325 56 ea # 16 93 pk Gyratory Disc 150mm (500 per pk)
21 ea 1/2" 57 ea # 30 94 gal Mechanical Pump Flushing Oil
22 ea 3/8" 58 ea # 40 95 gal Mechanical Pump Fluid
23 ea 3/4" 59 ea # 50 96 roll NCAT "Thermal" Paper
24 ea 1" Pan 60 ea # 80 97 box Turkey Tag (49T) (100 per bx)
25 ea 2" Pan 61 ea # 100 98 ea Turkey Tag Crimper (49S)
8" Half-Height 62 ea # 200 99 ea Sieve Brush / Flat Wire
26 ea # 4 63 ea # 270 100 ea Sieve Brush / Angled Head
27 ea # 8 64 ea 1/4" 101 ea Sieve Brush Round Soft __ Coarse __
28 ea # 16 65 ea 1/2" 102 ea 4-Inch Duro 60 Compression Pad
29 ea # 18 66 ea 3/8" 103 ea 6-Inch Duro 60 Compression Pad
30 ea # 20 67 ea 3/4" 104 bg Basolit Sulfer 50lb
31 ea # 30 68 ea 1" 105 bx QC-7 Asphalt Sample Tags (Manila)
32 ea # 40 69 ea 1-1/2" 106 bx QC-7 Asphalt Sample Tags (Orange)
33 ea # 60 70 ea 2" WRITE-IN REQUEST
34 ea # 80 71 ea 2" Pan 106
35 ea # 100 72 ea 3 1/4" 107
36 ea # 120 73 ea Cover 108
Notes: _____________________________________________________________________________________

M&T LAB ___ DIV-QMS LAB __ Div ___ City _______________________ Courier # ____________

Approved By: (Print) _______________________ Sign: ________________________ Date: ___________

Stockroom: (Initials) ____________ Date: ___________ Back Orders: Yes __ No __