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Concrete Equipment Procurement Request Form
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Concrete Equipment Procurement Request Form
Concrete Testing Equipment Request Form
Submission Date*
Required
Invalid Date Format, please use MM/DD/YYYY
Submitter Name:*
Required
NCDOT Unit:*
Required
Division:*
Division 1
Division 2
Division 3
Division 4
Division 5
Division 6
Division 7
Division 8
Division 9
Division 10
Division 11
Division 12
Division 13
Division 14
Other
Required
District:*
District 1
District 2
District 3
Other
Required
Resident Engineer / Supervisor:*
Required
Physical Address (Include Zip Code):*
Required
Phone:*
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Fax:
Email:*
Required
Cost Center:
Courier Number:
Items / Quantity
View the
Equipment Catalog
Swiss Hammer:
1
2
3
4
5
6
7
8
9
10
Concrete Vibrator:
1
2
3
4
5
6
7
8
9
10
Maturity Meter:
1
2
3
4
5
6
7
8
9
10
Maturity Probes:
1
2
3
4
5
6
7
8
9
10
Winsor Probe:
1
2
3
4
5
6
7
8
9
10
Type B Pressure Meter (Forney):
1
2
3
4
5
6
7
8
9
10
Volumetric Meter (Roll-A-Meter) (Forney):
1
2
3
4
5
6
7
8
9
10
Delivery or Pick-up Method
Select One*
Courier
Pick-up - 1801 Blue Ridge Road, Materials and Tests Office, Raleigh, NC 27607
Pick-up - 124 Prison Camp Road, Old Pavement Management Office, Statesville, NC 28625
*Please note items can be delivered via courier or can be picked up at one of our two office locations.
Required
Validating Fields
Submitting Form
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