Republic of the Philippines

Department of Public Works and Highways

BUREAU OF RESEARCH AND STANDARDS
EDSA, Diliman, Quezon City

SAMPLE CARD

Project : Chuzon Supermarket, Porac, Pampanga

(Name of Project) (City/Province)
Kind of material : Reinforcing Steel Bar (Deformed)

Sample identification :

Quantity represented : None except sample tested

Sampled at : Chuzon Supermarket

(Give accurate location if possible)
Original source :

Owner / Supplier :

Sampled / Cast by : Jayson R. Margallo, Engr.II / Melchor S. Gianan, L.T. II

(Name of DPWH authorized representative) (Signature)

DPWH - BRS
(Designation) (Office) (Date)
Proposed use : Concrete Reinforcement

Test desired : Quality Test

Governing Spec’s. : ASTM A-615 (Grade 40)

Shipped by : Jayson R. Margallo, Engr.II / Melchor S. Gianan, L.T. II DPWH-BRS

(Name & designation) (Office) (Date)
Send test results :

REMARKS :

Bill charge to

Submitted by :Jayson R. Margallo, Engr.II / Melchor S. Gianan, L.T. II

(Name & designation) (Signature)
DPWH - BRS

(Office) (Mailing Address) (Date)

Received by :
(Name & designation) (Date) (Time)

Amount __________________ Due Date: __________________ Lab. No. _______________________

Official Receipt no. __________________

NOTED:

REYNALDO P. FAUSTINO
Acting Director III