Form Ge-335 - Product Evaluation Form (Pef) For Geosynthetics
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1GE-335 (12/15)
New York State Department of Transportation
P
E
F
(PEF) f
or Geosynthetics
RODUCT
VALUATION
ORM
for placement on
T
S
M
A
L
: G
H
C
ECHNICAL
ERVICES
ATERIALS
PPROVED
IST
EOSYNTHETICS FOR
IGHWAY
ONSTRUCTION
Important: All information must be filled in or approval will be delayed. Please use one form for each
product submitted.
Date of Product Evaluation Form Submission:
_____________________________________
Product Brand Name: _______________________________________________________
Please Select the Type of Geosynthetic:
GEOMEMBRANE (
)
NYSDOT Standard Specifications §737-02
PREFABRICATED VERTICAL DRAIN (
)
NYSDOT Standard Specifications §737-03
PREFABRICATED COMPOSITE STRUCTURAL DRAIN (
)
NYSDOT Standard Specifications §737-04
PREFABRICATED INTEGRAL ABUTMENT DRAIN (
)
NYSDOT Standard Specifications §737-05
PREFABRICATED COMPOSITE EDGE DRAIN (
)
NYSDOT Standard Specifications §737-06
(Note: This form is not applicable for GEOTEXTILE (NYSDOT Standard Specifications §737-01XX))
Company Name
______________________________________________________
:
Company Website
______________________________________________________
:
Corporate Mailing Address: ______________________________________________________
______________________________________________________
Contact Person:
______________________________________________________
Phone:
__________________________________________________________
•
E-Mail:
__________________________________________________________
•
List all manufacturing locations of this product (list projected supplier of Product for NYSDOT first):
-
Facility Name, City, State/Prov., Country -
1
_____________________________________________________________________
2
_____________________________________________________________________
3
_____________________________________________________________________
If manufactured outside the USA, list locations of USA-based distribution facilities serving New York State:
-
Facility Name, City, State -
1
_____________________________________________________________________
2
_____________________________________________________________________
3
_____________________________________________________________________
Cover Geotextile Wrapping
(for Product Types §737-03 PREFABRICATED VERTICAL DRAINS, §737-04 PREFABRICATED
COMPOSITE STRUCTURAL DRAINS, §737-05 PREFABRICATED COMPOSITE INTEGRAL ABUTMENT DRAINS, & §737-06
PREFABRICATED COMPOSITE EDGE DRAINS in “Product Type” above):
Manufacturer: __________________________________________________________
•
Product Name: __________________________________________________________
•
NTPEP No.:
__________________________________________________________
•
Check box if YES:
Is the Cover Geotextile Wrapping listed on the current NYSDOT A
L
PPROVED
IST OF
G
, and is approved for Drainage applications? (required)
EOTEXTILES
Have you included a test data sheet identifying the products properties? (required)
Have you submitted a sample of your product to NYSDOT in accordance with the
appropriate NYSDOT Standard Specifications §737-XX? (required)
Please send completed form to: Director, Geotechnical Engineering Bureau, 50 Wolf Rd., Albany NY 12232 Attn: Soil Mechanics Lab
or submit completed form via e-mail to:
geotech.lab@dot.ny.gov
or
geotech@dot.ny.gov.
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