<p> Appendix 19B Bridge Rehabilitation Justification Report (each bridge in project)</p><p>Title: </p><p>P.I.N: B.I.N.:</p><p>COUNTY: PS&E:</p><p>INSPECTION DATE:</p><p>DESCRIPTION</p><p>YEAR BUILT: NO. OF SPANS: SPAN LENGTH: WIDTH: SUPERSTRUCTURE: SUBSTRUCTURE: SKEW:</p><p>Innovative or Unusual Structure: Y / N provide a brief description of any unique/unusual bridge components</p><p>PURPOSE and OBJECTIVES:</p><p>ELEMENT ASSESSMENT SUMMARY TABLE:</p><p>The element assessment table is to be filled out based on information gathered during the in-depth inspection.</p><p>2016 19B-1 NYSDOT Bridge Manual</p><p>STRUCTURE NEEDS AND PROPOSED WORK:</p><p>This section is to be used to briefly describe the condition of the element(s) and to discuss the proposed work to restore them. </p><p>UTILITIES:</p><p>This section is to be used to describe the utilities present or proposed.</p><p>2016 19B-2 NYSDOT Bridge Manual</p><p>HAZARDOUS MATERIALS:</p><p>This section is to document any hazardous materials and disposition of those materials</p><p>COMMENTS:</p><p>This section is to used for general comments</p><p>RECOMMENDED ALTERNATIVE:</p><p>This section used to justify the proposed work and cost of the rehabilitation alternatives investigated. If the proposed work is to be done in multiple contracts it shall be discussed here.</p><p>COST % Repl. COMMENTS Cost</p><p>Replacement</p><p>Rehab. Alternative #1</p><p>Rehab. Alternative #2</p><p>Rehab. Alternative #3</p><p>Recommended by: type name / title . </p><p>Signature: sign name . </p><p>Date: mm/dd/yyyy</p><p>Approved by: type name DCES</p><p>Signature: sign name . </p><p>2016 19B-3 NYSDOT Bridge Manual</p><p>Date: mm/dd/yyyy</p><p>2016 19B-4</p>