1. Home
  2. Programs
  3. Engineering Services (DES)
  4. Authorized Materials Lists (AML)
  5. Cementitious Materials for use in Concrete
  6. Notice of Intent to Supply Cementitious Material

Revised 8/13/2021

Notice of Intent to Supply Cementitious Material

Use this form to notify the California Department of Transportation that you intend to supply a cementitious material product to contractors for Department projects. Appearance on the list does not relieve the supplier of the responsibility to supply only materials that conform to the Department's specifications.

Instructions: Supply information for EACH material on a separate sheet. Return completed sheets to: Caltrans, 5900 Folsom Blvd, Sacramento CA, 95819, Attention: Ben Lenz OR by email to cementitious.materials.AML@dot.ca.gov. Instructions for submission of this form via email are given below.

S U P P L I E R   I N F O R M A T I O N

Date: 

Supplier Name: 

Supplier Address (HQ): 

City:  State:  ZIP: 

Contact Name: 

Email:  Phone: 

AASHTO Accredited lab which will perform testing:

Lab Name: 

Lab Address: 

P R O D U C T   I N F O R M A T I O N

Product Name: 
  Type of Material Specification  
Portland Cements
  II ASTM C 150
  II/V ASTM C 150
  V ASTM C 150
  III ASTM C 150
Blended Cements
  IL AASHTO M 240
  IP AASHTO M 240
  IS AASHTO M 240
  Fly Ash – Class F (CaO<10%) AASHTO M 295
  Fly Ash – Class F (10%<CaO<15%) AASHTO M 295
  Ultra-Fine Fly Ash AASHTO M 295
  Natural Pozzolan AASHTO M 295
  Slag (GGBFS) AASHTO M 302
  Metakaolin AASHTO M 307
  Silica Fume AASHTO M 307
  Other  
 

Source Name: 

Source Address: 

City:  State:  ZIP: 

Additionally, for Foreign Sources:

Country of Origin: 

Import Terminal Address: 

City:  State:  ZIP: 
Email form submittal instructions: Fill in text boxes, click on [email] button below to open your email client and then press [control]+v keys to paste all data to the body of the email. Edit as needed and then send the message. Refresh the browser to view text boxes again if changes need to be made.