Form No.

KDP-V442-ITRR-F03-RO
NEW CENTENNIAL WATER SOURCE - KALIWA DAM PROJECT)

INSPECTION AND TESTING REQUEST/REPORT

Contractor: CEEC Contract Number: NCWS-KDP-001-2018

IRF Number: ITRR-MAT-130 Date Prepared: 15-Nov-22

Construction Activity for which inspection is requested:

Ref. Pay Description Location Date Time Remarks
Item No.
Compressive Strength Test (In-House):
Structure: Precast Segment
November
5B,5C,5D,6B,6C,6D,7B,7C,8C,8D,9B,9C,9D, Weekly In-House Quality
CEEC 12,18,25
ITEM 405 Sampled: November 11, 2022 10:30 AM Testing @ CEEC
Laboratory December
Sample Age: 1,7,14,28 Days Laboratory
9, 2022

Requested by: Received by

Signature Name
Name AB. LAUZON / D. CALIWANAGAN / MM. MAGADIA Title
Title Material Engineer -II / Material Engineer - II / QAQC Mgr. Date
Time
Signature
Name LIANG TAIJING / JAIME GUEVARRA
Title Department Manager / Project Manager

Result of Inspection

Inspected by
Testing Needed Survey Needed
Signature Yes No Yes No
Name
Title
Date
Time

Result of Test / Survey

Test/ Survey witnessed by Request to proceed is

Approved Disapproved
Signature
Name Signature
Title Materials Engineer / Qty. Surveyor Name
Date Title Resident Engineer
Time Date
Time