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<br />U.S. DOT CROSSING INVENTORY FORM
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<br />OMS No 2130..0017
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<br />A. InlllillUnll AQltMY l]('$lal~ B. Crllliltlng N\lm~llr (max, r a/1ar.) C. Rllilllion lor Updlltll O. ti,tlllctlvlI Oalll
<br />o Rllilr~lllcl ~'\ \ f) ; ~ y ~M8nQe3ln 0 New Croli~lng Cl Claaecl Crpaalng (MM/OON'Tfl
<br />. a~ilillnQ Dalll . .. or }\,bsndllned o'Plt~ oS
<br /> Pltrt 1:l.o11atlol1ltnd Clltulncatlon InlonnlltJon
<br />1. Railroad Qpar. Ca, (codll (mill!. 4 ohllr.) or nllme) 2. Slale (2 o/1ar.) 3. Ccunly (mall ~O ohllt.)
<br /> '5CO MN Oo-.~6Ta..
<br />4. Railroad Olvllilon Qr Region (mllx. 14 ahar.) 5. Rallraad S\lbcllvllilon ar Olstrlcl (max. 14 ahar.) a. Branch or I.lne Nllml! (msll.ll1 char.) 7. RR Mllilp081 (mox. 10hor.)
<br />~ ?o.W \ SeN i~ R \ \j.e..<' Mo.i {J (nnnnn,nn)
<br /> O:,qt,O"
<br />S. RR I.D. No. (max. '10 char.) 9. Nearest RR Timetable Statlan (max, 15 char,) 10, Parent RR (max. 4 ahar.) 11. Croaslng O\yner (RR or Compliny name)
<br />(opllonal) 1ia.s-n \/.c\S (If applicable) (If applloeble)
<br /> c..P ~
<br />12. ClIy (maxt!11rhar.) 13. Streel or Road Nail'll! (m~x. 17 char.) STATE SUPPLIED INFORMATION
<br />(check In Me. 'S\l n~5 'Sec.c (j ~ S-lr 21, HSR Corridor fa (2 char.)
<br />ono) 0
<br />Near
<br />14. HlghWIIY Typa & No. (max, 1 ahar.) 15. eNS Sign InsllAlled (1-800) Hl.aula~ 22, County Map Rllf. No. (max. 10 char.)
<br />\'()0 (') q o YIIS ~o o Partial
<br /> o 24hr o Unknown 23. Latitude (max. 1 a ahar" nn.nnnnnn")
<br />17, CraMlng Typo 1 a. CroulnQ p051Uon 19. Cr' of PIISltenoer 8Mrvics 20, AW1l\\gll Pll1l811nUllf Train
<br />(chou.e 00. umy) ~Gradll AMTRAK Count Per OM 24, Longitude (mllx. 11 ahar" nnn.nnnnnnn)
<br />~ubll': o RR Wnder ~MTRAK & Othar Z
<br />o PriVate o FIR OW/I o Other 2~. LallLong Sour~a
<br />o (ledestrilln o Nanll o Aclual o !t$tlmaled
<br />28. leThllrlllln Adlil~QII'lnlil WIth II SIlPllreta Number?
<br />o Yell No II YIlS, Provide N\lmbor 17 I,lharaclofs)
<br />27, PRIVATF; CROSSING INFORMATION
<br />'If ,A. Category 27,a. PUblic Acccss 27,C. Signs/Signele
<br />Ich.uk on.} o Rllcrutlonill o Yell o Nonl!
<br />o Farm o Indullrtfll o No o Signs Specify (mllx. 15 allllf.)
<br />o Resldllntllll o Commercial o Unknown o Slgnala Specify (max, US chor,)
<br />2B.A. Railroad Usa (max. 20 ahar.) 29,A, Stalll Use (max. 20 char.)
<br />2B.B. Railroad Ulte (max. 20 char.) 29,13. Stale Use (mllx. 20 char.)
<br />2B.C. Railroad Use (max. 20 ahar.) 29.C. State Use (max. 20 char,)
<br />2S.D. Railroad Use (max. 20 char.) 29,0. State Usa (m<lx. 20 char,)
<br />30. Narrative (mall. 100 char.)
<br /> . ;'
<br />~1, emergency Cantact (Telephone No.) I 32. Railroad Cantllcl (T"laphonll No.) I 03. Stllte COnlael (Telllphone No.)
<br /> MUST COMPI.ETE REMAINDER OF FORM FOR PUBI.IC VEHICLES CROSSINGS AT GRAOe
<br /> Part III Railroad Infonnatlon
<br />1. Numb.r of Ollily Trllln Mpvllmenta
<br />1.A. Tolal Train. 1.e. TOIIII ~\'Iilllhlna Treln, 11'C. Tlltal Ollyllght Thru Trplna (8 140 a PM) .'1.0. C:hllc~ I' \.011I ThilnOne MQVlImllnl Plitr Oay
<br />28 0 0
<br />"
<br />~, Spelld 01 Train al Croaalng 2,A, Maltlmum Time Tabla Splled (mph) JO 4 ~D
<br /> 2.13. Typical Speed Range Over Crossing (mph) from \0
<br />J. TYPII end Number 01 Trllckl Main Other If Other, SpeCify (max.10 char.)
<br />4. OQlla Anothllr RR Operate a Blparata Track al Crol.lng? 5. Ooal Anothllr RR Opllrute OVar YO\lr Track at Croaslng?
<br />o Ya~ /I Yes, Specify RR (max. 16 char.) [9"'Yaa :t:c.J:l Y.asf,.~ R~ (max. III ohar.)
<br />~o , . o No
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<br />papl\R'I'M/lN'I' 01' 'I'IlANlIPQR1A'I'lQN
<br />PICIiRA, RA'CRClAll AOMIN'~TRATION (pRAI
<br />
<br />FORM FRA F 6180.71 (Rev. 11/99)
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<br />OMS approval expires 8/31/2009
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