For laboratory use only

Public Works Laboratories Collection Request No. (CRN)

Geotechnical Engineering Office, Hong Kong
Test Request No. (TRN)

Form Reset
TESTING REQUEST FOR REINFORCEMENT CONNECTORS
Account No. (if available) Customer Test Request Ref. No.
(Please provide the following project information if account no. is not available)
Customer (Works Dept/Office) Contract No.

Job Title Job No.

Work/Site Location

Please test the accompanying reinforcement connector sample(s) in accordance with : (Please select the appropriate box)

□ GS:2006, specified characteristic strength of bar __________ □ COP 2004, Cl 3.2.8.2, Grade of bar _________
□ AC133:2008 for ACI 318 Type 2 Mechanical Connector (UBC/IBC*), specified yield strength of bar ____________
specified tensile strength of bar ___________
□ COP 2013, Cl. 3.2.8.3, Grade of bar____ , □ COP 2013, Cl. 3.2.8.4, specified yield strength of bar________
specified tensile strength of bar ______

Customer Nominal Bar Bar heat/

Number of Product Product Connector
Sample Sample description bar size pattern cast Remarks
specimen name type grade
Ref. No. (mm) code No.

(1)
Note:- To be completed by a project works supervisor grade officer or above.
(2)
To be completed by a project inspectorate grade officer or above (or his delegate).
* Delete as inappropriate.

Sample(s) delivery supervised/handed over* by(1) Test(s) requested by(2)

Signature : Signature :
Name : Name :
Post : Post :
Tel./Fax No. : Tel./Fax No. :
Date : Date :

Fill in the box below the name, mailing and e-mail address to which the test report/certificate(s) should be sent or else mark □
“To be collected” if the customer requests to collect the report/certificate(s) from the laboratory in person.

Preliminary results

Fax No. Print

C Eng D (GEO) 2413 Oct 2018