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<br />U.S. DOT CROSSING INVENTORY FORM <br /> <br />S. emuln; Nllmbcr (mIx. ., ~hftr.) O. Effllc:t1vc Oalll <br />~\ 1..33,/ PAGE 2 (MMIC07{YYl <br /> o 4?,) I ~2.CO f;) <br /> . Part III: Trllffl<: Contrlll Cavlc. Informatlol'l <br />1. No Slgnl or ISlgnals 2, Tvnll 01 WarnlMOevlcll at Crllsalna . Sinn. iaollcl/v number 01 aacMI . <br /> 2.A. Cro'.bUQ~a ::1.13. Highway Stop Slgnl (RH) :l.e. RR Advlnco W!lrnlng 2.0. Hump Cr08alng Sign (W10.5) <br />o Check II OCr/ocl Signa (W1 0.1) o Ve. ~ o Un~nown <br /> (9Aflll ',0 No <br />2.E. Pavement M!lrklngs ;!.F. Other Signs (IJPecify MUTeD type) 2..\~-'2. <br />o Stopllnes o RR Xing Symbols ~one Number '2. Specify Type (max. 10 char.) <br /> i Number Specify Type (max. 10 char.) <br />3. Type of Wamlng Device at Crossing - Train Actlvated Cevlces (specify 'lumber of each) <br />3.A. Galea 3.6. Four-quadrant (or 3.C. Cantilevered (or I3ridged) Flaehlng Llghte 3.0. Masl Mounted J.E. Number of Flashing <br />'2- rull barner) Gales Over Traffic Lane (numCsr) 0 Fluhing L1ghls (number) Light Peirs <br /> o yn u;:rN'0 Not Over Tr!lffic Lane (number) ---C! .:L 2.. <br />3.F, Other Flashing 1.19htl- 3.0. Highway Traffic Signals 3.H. Wigwags (numbor) 13.J. Blllls (numbor) <br />Numbl'lr 0 Specify Type (mll~. 9 ~har.) rnumb~r} 0 a 0 <br />a.K, Other Train Acllveted Warning Oevlctt: (sp,elfy) <br />(mIlN. 9 aher.) <br />4. Spoc;1rY apllclal Wllrnlng Device NOT Treln Acllveted (moil. 20 ahor.) 6. Chllnno"~atll;ln Dllvlqas \^I'IIh Gates <br /> ~ Aprooch!lsD Ono APprllflch o Nano <br />a. TrAin Dllteellon 7. Slgntllllng IQr Trllln Opofllllon: a. Tr.f11c Llghllntllrcc:mnecrtlcn/Pr"mptlon <br />r:sa1onshlln\ Wilrnlng Time CJ DCIAPO III Treck i:q~llppl!d with Treln Slgnels? o Ncllnllllcannllchld lErN1A <br />o Motion Palectar. o Other [g1',a o Simultaneous Preemption <br /> o /(lIme ON" o Advance F'reempllon <br />9. Rt'lsolVed Far Fulurlil LJSO 110' AesiJIVed F~r Fulllro Use /11. ReaeIVlld For Future Uee 112. RlillllIVeq FOI Future Ule <br /> Port IV: Phyelcal Charoctllrlltlce <br />1, Type of Oevelopment Gr'C"mmeralal 2. Smellllat Clo.slno Anole ~. . ao' <br />rl Open SpeCIl n RlIsldenllal o Induslrial o Institutional o 0'.29' n 30'.59' <br />3. Numbor of Traffic Lane. 2- 14. Are Truck PUIIO~S Present? 5. Is Highway Paved? <br />Crossing RallrQad o Yel 0 ~s ONe <br />6. Crossing Surface (on main IIno) <br />o 1. Timber o 2. Asphelt o a. Asphait end Flango- o 4. Concreto o 5. Concrete and Rubbor <br />~ Rubber o 7, Metal o a. Unconsolidated o 9. Other (Specl'y) <br />7. 00111 Track RUn~J Slraat? I a. Nearb Intarlectlng Highway? n 200 10 500 'llot o N/A lilt Signalized? ~5 <br />o Yel 0 ", [Q Loen than 16 factt 0 75 to 200 Illftt <br />9, II C~O"lng lIIumlnlltad? (Slrelltll8hll 10. II Commercial Power Avullallle? 11. ~pllCII Rll.lINed For Fulur. USll <br />~ appro~. 50 rOllt frol'l1 nellr'l roll) ~a o NCI <br />Yla 0 Nil <br /> PlIrtVI Hlol1way InflJrmallCln <br />1. Highway SYllem ~. II crll8slnl} 1m Stelll Hlghwav Syatem'i' ~. PundlClnlll Cliltlmcllllon 4. r:'oalad Highway :Speld <br />o lol.rllt'lll'l C1l'lIdllrlll Aid, Nllt NHS ~CI Ilf RClijd iii Craning aG <br />o Nil!. Hwy Sysllilm (NHS) ~on "Ild,rlll Aid o Viii U r \oO,n Cb\\~ <br />o. Annlllll Aver.gll Oaily Trat11e (MOT) - 6. i1!sllmatll filercont TrycKI 7. AVI"~ll,Number of aohool 6uaos <br />Yellr ~C$ MOT.. \ ~'1 h- 50)(,) Ollllr . roa.ing pllr School Day 0 <br />li'ubllc reporting burd.n fQt 1I11.lnlolll1lllon colleotlon la 'It'mlt.d to avofllU. 18 mlnut., pDr raDpona., Incluellng lIlo time for rovlawlng Inatrucllona, ..archlngexlallng dill <br />aOIl/cO., galll.ring ond malnlllnlntll11a datil needed, and 'IImp,.tlng and fIIvlowlng tIl. 1I0llDllllon 0' Inlolll1allon, ..haordlng to the Paporwork IIoduallon Aal or 1au, a fad.,a' <br />- eUlnGY may not aondual or aponlor, end I penlon II Itol raqulred to ",epond to, no' Ihlll a pUrlIon bo .ubJ.at tn. penllly for /lIlIurelo comply "1111I. a coll.atlon o' <br />- lnfomtltlon .u"I... II dl'pl.y. I ourronlly Vllld OMS control number, 'The Vllld OMS conlTOl number for thll Inlomtatlon Gall,GUan I, 2130-0017. All r.apon..a to thll <br />Gollocllon llllnfl'lmtatlon Ira voluntary. S.nd comm.n~ regt/dlng thla burdan leUmata or any oll1ur aapect or 1111, oOlleollon, lilaludlng suugaallan, for nsdulI/no 1Il1, bllrd.n <br />to: Inromt_tlon Oollaallon Omoor. Pedoral Rallread Admlnl.trallon, 1120 Vannont Avo., N.W., Wa.hlng!an, 0.0. 20400. <br /> <br />14 <br />