MATERIAL SUBMITTAL FORM (FRONT COVER SHEET)

Division Office / Project : Engineering

Project No.: 0238 Date: 09/08/2014
Materials submitted for Reviewed : Concrete Block

Location/Area: Main Building Initiator: Yuda. P
Spec Ref/Drg Nos.: Key Word:
Discipline: Civil Structural Architectural E&I Mech Other: (specify)

Document No. : Rev Title of Document Review by Date

Concrete Block Regular Full 10.01
LCI-S-SB-ZZ-0003 00
Cisangkan (Sample)
Specification of Cocnrete Block Regular

Full 10.01 - Cisangkan
Product Data Sheet CISANGKAN

Signed: Signed (Recipient):

Name: Yuda. P Name:
Please sign copy and return to sender Date Received:

CLIENT / CONSULTANT RESPONSE

FROM : DATE :
NAME :
Reviewed with no objection (use as is)
Reviewed with comments (incorporate or implement the comment, then proceed. Further re-submittal may be
required, if specified)
Rejected (resolve the unacceptable condition as per the noted comments and resubmit before proceeding
Reviewed
Comments :

Signed: Date:

Name:

May 2014 Page 1 of 1 LCI-ENG-FM-008E(01)