TEST REQUISITION

Request No: Sample No.: Date of Request:

GHANTOOT TSPT &GEN.CONTRACTING

Contractor : L.L.C(Electrical Projects Division) P.O.Box: _____ Tel: ________ Fax: _________
___________________________________
Client : MUSANADA

Consultant : DORSCH GRUPPE DC ABU DHABI

CONSTRUCTION OF INTERNAL ROADS & INFRASTRUCTURE WORK FOR SECTORE EAST -25,PHASE-2,
Project : ABU DHABI
Contract No : ____________________________________________________________________________________

Sample description : LDPE Tiles(ADDC) 1000X250X6 MM Sampling Date : 27/06/2018

Sample Identification : Delivery No: SV 15403 Sampling Method : ASTM D75

Source of Sample : E-25 Site Store Sampling Certificate : _N.G______

_N.G._____
Sampled by : Consultant /Contractor Lot No. : ____
_N.G._____
Sample brought in by : Consultant /Contractor Lot Size (m3) :
______

Test Method
Sl. Test Required [Please Tick [√] the selected test methods] Number
No. [Please Tick [√] the selected tests] of tests
Standard
Dimension Check (Thickness, Width &
1 BS EN ISO 527 parts 1, 2 & 3 1
Length)
2 Ultimate Tensile Strength BS EN ISO 527 parts 1, 2 & 3 1

3 Elongation( Longitudinal & Transverse) BS EN ISO 527 parts 1, 2 & 3 1

4 Discoloration (Sulphuric acid )Test 1

Remarks:
If Additional test required:
Note:

______________ _______________
Contractor Consultant