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Approval of Material Sample

Project Title : Approval No.:


Location : Date :
Contractor :

CONTRACTOR’S USE
We are transmitting for your review and action of the following:

Item : Submitted by:


Location :
: Contractor’s Authorized
Specs & Reference
Representative
Position:
Source :
Date :

OWNER’S USE
Comment/s: Action/Recommendation:
Approved
Approved as Noted
Revise & Re-submit
Disapproved

Evaluated by: Approved as Recommended by:

Date Signed: Date Signed:

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