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MUNICIPAL CORPORATION OF GREATER MUMBAI

Ref No.

Application for testing of Material Sample


To,
Assistant Engineer ( Soil Mech)
Material Testing Laboratory, Worli

Sub.: Testing of Asphalt Conctrete(AC)

I am Sending here with the 1 sample of AC for testing. The details of the work are as follows:
Name of Department :
Report to be sent to : Executive Eng. K/West Ward
Name of Work & Work Code :
Name of Road : Yavateshwar Road
Ward in which work is going on : K/West Ward
Name of Contractor :
Name of Supplier :
Date of Laying :
Load No :
Tests to be performed : 1. Bitumen Content
2. Gradation
3. Marshall Stability
4. Voids
5. Flow
6. Hardness No.
7.Any Other test needed by the Department
Additional Information if Any :

Signature of Site In Charge


(With Designation)/ Ward

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