RECOGNIZED Product Submission File Number PRODUCT SUBMISSION FORM

For New Product Submissions to the Ministry

PLEASE COMPLETE FORM in FULL Incomplete applications will be returned.

Send/submit an email with this form completed in an electronic word format document to our e-mail address: [email protected]

(In addition, you may mail supporting product information with a copy of the completed form to our mailing address or attach PDF files of supporting documentation to the email)

Please provide requested information in the fields provided (you can type directly in the grey shaded field boxes) as this information will be used by the Recognized Products Evaluation Standing Committee to assist in the review of the product use and application. 1) Supplier’s Name: Address: City: Prov./State Postal/ZIP: Tel: Fax: Email Contact: : 2) Manufacturer’s Name (if different than supplier): Address: City: Prov./State Postal/ZIP: Tel: Fax: Email Contact: :

3) Applicant’s Contact Information Print Name Date Email address for contact person: 4) Product Name:

Product Application Details (Describe the product’s application and/or use):

Identify suitable Category from the Ministry’s Recognized Product List or propose a related Alternate Category:

* Where is the product listed for acceptance or approval in other North American Transportation Agencies?

Provide supporting documentation with contact name, email, and telephone reference of where the products is approved or listed in other jurisdiction’s Product’s List: * Provide supporting information/materials/results (i.e. details of product trials or tests) :

New Products Submission Form – January 2015 Page 1 of 4 * Starred fields must be completed or applications will be returned. Recognized Product Submission Form (cont’d)

5) Has this product been evaluated for environmental impact? Yes No If yes, attach environmental studies.

6) Is this product WHMIS controlled? Yes No

if yes, attach/send MSDS (note: MSDS must conform to WHMIS standards). Provide/Attach details: Does this product meet the requirements of a recognized specification agency (i.e., CSA, ASTM, CGSB, AASHTO)? Yes No If so, state agency and specification number(s):

Provide independent supporting letter/reports confirming compliance to standards and/or successful testing results.

7) Provide all other information that you is relevant to assist the RPL Committee to appraise this product’s use? Provide/Attach details:

8) Some criteria the RPL Committee uses to evaluate a product submission Provide details that can support the Product’s Function: Safety: Environmental: Durability: Life Cycle: Permanent Installation:

A response for the product’s submission will be issued upon receipt of application, initial appraisal, and committee result.

Received Initial Response Review Result Committee Result Notification

Date: Reply/Discussion: Advise Applicant: AcceptedUse: Proven Use: Advise Applicant:

Tran-24100-40/54506A Not Required:

Product Name/Description: Rejected for Use:

Product Number:

160000 – OPERATIONAL MATERIALS – Recognized Products

Ministry Reviewer(s): Date:

Comments:

New Products Submission Form – January 2015 Page 3 of 4 MINISTRY OF TRANSPORTATION INTERNET ADDRESS: and INFRASTRUCTURE Electronic Submission http://www.gov.bc.ca/tran Geotechnical Materials mailto:[email protected] and Paving Engineering http://www.th.gov.bc.ca/publications/eng_publications/geotech/rpl.htm PO Box 9850 Stn. Prov Govt Victoria BC V8W 9T5 tel:250.387.4360 fax:250.387.7735