Engineering Construction Department

CONSTRUCTION COMPLIANCES AND MATERIALS TESTING DIVISION

WORK REQUEST FORM

(WRF No.VSUP1-TAB-CCS-2023-104)
Date: 02-Sep-23

A. GENERAL PROJECT DATA

VISAYAS SUBSTATION UPGRADING PROJECT, STAGE 1 (REBIDDING) - TABANGO

Project Name :
SUBSTATION

Project ID : Sp19.VSUP1.Vt-0422R CC No./WBS No.: 85430701

Project Phase : Pre-Construction X Construction

B. SCOPE OF WORK

We are requesting that the following tests be performed by your group:

To conduct Compressive Strength Test on concrete cylinder samples taken during the concreting
works/
pouring intended for VSUP1-0422R- TABANGO SS PROJECT as follows:

Sample Description Date of Sampling Quantity Unit

DAS-RDS5 FLOORING PORTION 1 08-Aug-23 1 set/s

Source: : Julita River, Julita, Leyte (Supplier: Red Dragon Aggregates)

Requirement : 3,000 psi @ 28 days

Requested by: Received by:

Jobert Cayubit Jr.

Construction Projects Supervisor/ CMTS Personnel Date
Field Inspector/Contractor
C. CERTIFICATION OF SAMPLE AUTHENTICITY

This is to certify that concrete cylinder samples is/are taken from

(description of sample)
site on 08-Aug-23 as indicated above.
(souce or on-site delivery) date of sampling

MICHAEL Y. MARCO 02-Sep-23

Construction Projects Supervisor/ Date
Field Inspector
D. VERIFICATION OF SAMPLES
Delivery /
Sample Description Source Stockpile Remarks

As stated above N/A Verified as to email photo/s

KEITH REYMON T. REBUYON August 21,2020

CMTS Personnel Date of Testing Date of Release of Test Results

FM-ECD-05A Rev. 3 Page 1 of 1