EMPLOYER ENGINEER CONTRACTOR

APPROVAL MATERIAL
Date : July 09th, 2019 No. Approval : DWW/QC/AM/TM/2019/008

MATERIAL DATA

1 NAME / TYPE OF MATERIALS : Ready Mix of Concrete

2 BRAND/SOURCE : Plant Cikande

3 MATERIAL CODE / TYPE : Concrete fc 240 kg/cm2 ; fc 210 kg/cm2 ; fc 180 kg/cm2 ; K-125 kg/cm2 ; K-350 kg/cm2

4 MANUFACTURER : PT Farika Beton

5 BASED ON REFERENCE :

a. Technical Specification : Sub Clause 6.1.3 Mix Proportion of Concrete Work

b. Bill of Quantity (BoQ) :

c. No. Construction Drawing :

d. Others :

6 LOCATION :

7 SUPPORTING DATA :

a. Brochures of Material : √ c. Certificate of Material √

b. Sample of Material : √ d. Shop Drawing

REMARKS :
BASED ON APPROVAL*
1 COMPATIBLE / NOT COMPATIBLE WITH TECHNICAL SPECIFICATION
2 COMPATIBLE / NOT COMPATIBLE WITH MINUTES OF MEETING / LETTERS
3 COMPATIBLE / NOT COMPATIBLE WITH SHOP DRAWING
4 QUALITY OF PRODUCT GOOD / BAD *according to basic reference
BASED ON EVALUATION
SUBMISSION OF THE MATERIALS ACCEPTED / REJECTED
COMMENTS :

EMPLOYER ENGINEER CONTRACTOR

Acknowledge & : Employer Received by : Inspector Prepared by : QA/QC Staff
Approved by : Date/Time : Date/Time : July 09th, 2019
Date/Time

(............…………………………..) (............…………………………..) (………………………….)

Checked by, : Engineer Submitted by : QA/QC Manager
Date/Time : July 09th, 2019
Date/Time :

(........................................) (RIFQI FIRMANSYAH)