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SNIMIZU.

FuITA
TANENAKA- FE N METRO MANILA SUBWAY PROJECT PHASE 1
CPI01:THREE (3) UNDERGROUND STATIONS, TUNNELS &
DEPOT CONSTRUCTION, DEPOT EQUIPMENT &BUILDINGs
Contctot

SAMPLE CARD
Project Name METRO MANILA SUBWAY PROJECT PHASE 1- CP101: THREE (3)
UNDERGROUND STATIONS TUNNELS &DEPoT
CONSTRUCTION, DEPOT EQUIPMENT &BUILDINGS
Sample D
RIN Reference No
Kind of Materia
MMSP-SFTEJV-101-TB1-RIT-QAC)-900193
40.32Mpa cored sample cylinder
aty. Representative : 1SET
Sampled at : : SFTE JVTUNNEL TEAM SUB-OFFICE. 5101 LAZARO ST. BRGY UGONG.
VALENZUELA CITY
(Gve Accurste Locson a5 sssce)
Original Source: SFTEJV TUNNEL TEAM SUB-OFFICE 5101 LAZARO ST.. BRGY. UGONG, VALENZUELA CITY
Ownerl Supplier : SFTEJV

Proposed Use
Test Desired: COMPRESSIVE STRENGTH TEST-7 days
Specifications : 40.32 MPa AT 17days(85% of 48Mpa)
Bill Charge to :
Send Test Result to :
SHIMIZU-FUJITA-TAKENAKA-EEI JOINT VENTURE
(Name t Comosny)
: LOT 3B-4A, MINDANA OAVE. GATE NO, 02 NR VMMC-VGC
CLUBHOUSE. PROJECT6. DISTRICT 1, QUEZON CITY 1100, PHILIPPINES
(Naing address).
Remarks: Cored sample on K-segment Ring ID 1642

Sampled / Cast by:


VEREY AMBA
(Name
T.E
(Designation)
SFTE-JV
(Signatue (Ottce) (Data)

Witnessed by
ALNIXON DOMINGO QAQC ENGR. SFTEJV 2 t 2
(Name) (Desgnaton) (Ottce) (Date)

(Name) (Designation) (Signalure) (Otco) (Dato)

(Name) (Desgnation) (Signatur) (Oce) (Cate)

(Name) (Desonaton) (Signalue) (Oce) (Date)

Submitted by:
(Name) (Dasgnalon) (SignaBure) (Ortcej (Data)

Witnessed by:
(Nane) (Desgnation) (Signalure) (0Vtce) (ae

(Nate) (Dcsnnalon) (Signatura) (OMce)

(Name) (Desgnaion) (Sgnaluse) (Otce)

(Wone) (Desynalon) (SignaluN) (0tuo) (

Received by
(Nama) (Desynabn) (Signatu) (#ce)

Due Date Lab, No,


Sample Card No.
O.R, No,

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