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-131 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):
Sampled: November 8, 2022 November
Structure: Precast Segment: 1-A,1-C,1-D,2-A,2-B, 9, 15, 22 Weekly In-House Quality
CEEC
ITEM 405 2-C,2-D,3-A,3-B,3-C,3-D,4-A,4-B,4-C,4-D,5-A,6-A, December 10:30 AM Testing @ CEEC
Laboratory
7-A,7-B,7-D,8-A,8-B,9-A,10-A,10-B,10-C,10-D 6, Laboratory
Sample Age: 1,7,14,28 Days 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