SAMPLE CARD

Project : Concreting of Jct. Kiokong-Dumalama-Magsaysay Road, Quezon Bukidnon

(Name) (City/Province)
Kind of Materials : Corebore
Sample identification : Station 0+590 to 0+840 LL (December 30, 2020)
Part of Structure : PCCP
Quantity represented :
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Randy P. Diaz/Genevieve Gayoso
(Name of authorized representative) (Signature)
: ME/MTQA PEO-Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Randy P. Diaz -
(Name and Date) (Signature)
: PEO-Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
SAMPLE CARD

Project : Concreting of Jct. Kiokong-Dumalama-Magsaysay Road, Quezon Bukidnon

(Name) (City/Province)
Kind of Materials : Corebore
Sample identification : Station 1+580 to 1+840 LL (December 23, 2020)
Part of Structure : PCCP
Quantity represented :
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Randy P. Diaz/Genevieve Gayoso
(Name of authorized representative) (Signature)
: ME/MTQA PEO-Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Randy P. Diaz -
(Name and Date) (Signature)
: PEO-Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
SAMPLE CARD

Project : Concreting of Jct. Kiokong-Dumalama-Magsaysay Road, Quezon Bukidnon

(Name) (City/Province)
Kind of Materials : Corebore
Sample identification : Station 0+930 to 1+080 LL (December 12, 2020)
Part of Structure : PCCP
Quantity represented :
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Randy P. Diaz/Genevieve Gayoso
(Name of authorized representative) (Signature)
: ME/MTQA PEO-Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Randy P. Diaz -
(Name and Date) (Signature)
: PEO-Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : Coarse Aggregates (G-3/4")
Sample identification :-
Part of Structure : Structural Concrete
Quantity represented :
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : Fine Aggregates
Sample identification :-
Part of Structure : Structural Concrete
Quantity represented :
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

PAZ T. DELA CRUZ

Chief, Quality Assurance Section
Republic of the Philippines
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : Soil Aggregates
Sample identification :-
Part of Structure : Embankment
Quantity represented :
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : Angle Bar 11/2"x11/2"x1/4"
Sample identification :-
Part of Structure : Roof Truss
Quantity represented :
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : Angle Bar 2"x2"x1/4"
Sample identification :-
Part of Structure : Roof Truss
Quantity represented :
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : RSB 20mmØ
Sample identification :-
Part of Structure : CHB Wall
Quantity represented : 10,000 kg
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : RSB 16mmØ
Sample identification :-
Part of Structure : CHB Wall
Quantity represented : 10,000 kg
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : RSB 10mmØ
Sample identification :-
Part of Structure : CHB Wall
Quantity represented : 10,000 kg
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines MTS Form No. 01
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : Concrete Hollow Blocks 6" thck
Sample identification :-
Part of Structure : CHB Wall
Quantity represented : 10,000 pcs
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines MTS Form No. 01
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : Concrete Hollow Blocks 4" thck
Sample identification :-
Part of Structure : CHB Wall
Quantity represented : 10,000 pcs
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines MTS Form No. 01
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Project : Rehabilitation of Multipurpose Building (Municipal Hall) Poblacion Damulog, Bukidnon

(Name) (City/Province)
Kind of Materials : Cement
Sample identification :-
Part of Structure : Structural Concrete
Quantity represented : 2000 bags
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Jose G. Orzal
(Name of authorized representative) (Signature)
: Municipal Engineer Damulog, Bukidnon -
(Designation) (Office) (Date)
: Genevieve G. Gayoso
(Name of authorized representative) (Signature)
: Materials Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Genevieve G. Gayoso , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : Jose G. Orzal -
(Name and Date) (Signature)
: Damulog, Bukidnon -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines MTS Form No. 01
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Construction/Upgrading/Rehabilitation of Drainage along National Roads-Secondary Roads

Project :
Maramag-Maradugao Road K1558+079 to K1559+180
(Name) (City/Province)
Kind of Materials : RCPC
Sample identification :-
Part of Structure : DRAINAGE CULVERT PIPE
Quantity represented : 50 Pcs
Sampled at : Project Site
(Give accurate location possible)
Original source :-
Owner/Supplier : Mafil Builders, Inc.
Sampled/Cast by : Quennie I. Daypuyat
(Name of authorized representative) (Signature)
: Engineer II DPWH Bukidnon II DEO -
(Designation) (Office) (Date)
: Arianie S. Daming
(Name of authorized representative) (Signature)
: Project Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Arianie S. Daming , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : MARCELINO G. ANOC -
(Name and Date) (Signature)
: DPWH Bukidnon II DEO -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)
Republic of the Philippines MTS Form No. 01
Department of Public Works and Highways
BUKIDNON SECOND DISTRICT ENGINEERING OFFICE
PINAMALOY, DON CARLOS, BUKIDNON

SAMPLE CARD

Construction/Upgrading/Rehabilitation of Drainage along National Roads-Secondary Roads

Project :
Maramag-Maradugao Road K1558+079 to K1559+180
(Name) (City/Province)
Kind of Materials :-
Sample identification :-
Part of Structure :-
Quantity represented :-
Sampled at :-
(Give accurate location possible)
Original source :-
Owner/Supplier :-
Sampled/Cast by : Quennie I. Daypuyat
(Name of authorized representative) (Signature)
: Engineer II DPWH Bukidnon II DEO -
(Designation) (Office) (Date)
: Arianie S. Daming
(Name of authorized representative) (Signature)
: Project Engineer Mafil Builders, Inc. -
(Designation) (Office) (Date)
Proposed use :-
Test desired :-
Governing Specification :-
Shipped by : Arianie S. Daming , ME I Mafil Builders, Inc. -
(Name and Designation) (Office) (Date)
Send test results to : Mafil Builders, Inc.
: Purok 2, Patag, Bagontaas, Valencia City
(Mailing Address)
REMARKS : Please send test results as soon as possible

Bill Charge to : Mafil Builders, Inc. Purok 2, Patag, Bagontaas, Valencia City
Submitted by : MARCELINO G. ANOC -
(Name and Date) (Signature)
: DPWH Bukidnon II DEO -
(Office) (Date)

Received by :
Due Date : Lab. No.

NOTED :

(Head of Office)
(Designation)