Item 311 UBI Angel Region
Item 311 UBI Angel Region
Item 311 UBI Angel Region
02
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
AGUSAN DEL SUR 2ND
DISTRICT ENGINEERING OFFICE
REGIONAL OFFICE XIII
San Francisco, Agusan del Sur
R.13/12.6/qas/edc.
MTS Form No. 02
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
AGUSAN DEL SUR 2ND
DISTRICT ENGINEERING OFFICE
REGIONAL OFFICE XIII
San Francisco, Agusan del Sur
Project : 22NO0128 -
0
(Name) (City Province)
Kind of Material : Fine Aggregate
Sample Identification : FA -01
Quantity Represented : 1,500 cu.m
Sampled at : Jobsite
Original Source : Sta. Josefa River Quarry, Sta. Josefa, Agusan del Sur
Proposed Use : For Reference
Spec's Item No. : 311 (AASHTO T 27/AASHTO T85/AASHTO T 84/AASHTO T 19)
Sampled by : LILIBETH T. TIROL/GINA T. PAZ -Contractor Representative 30-Dec-1899
: (Name & Designation) (Date)
Submitted by : J.M. LUCIANO Construction Incorporation - Representative DPWH ADS 2ND DEO 6-Jul-2022
: (Name & Designation) (Office) (Date)
R.13/12.6/qas/edc.
R.13/12.6/qas/edc.
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
AGUSAN DEL SUR 2ND
DISTRICT ENGINEERING OFFICE
REGIONAL OFFICE XIII
San Francisco, Agusan del Sur
Project : 22NO0128 -
: 0
(Name) (Number) (City/Province)
Contractor : #NAME?
(Give as accurate location as possible)
Original Source : Simulao River Quarry, Sta. Maria, Trento & Sta. Josefa Quarry, Agusan del Sur
(Pit, Quarry, River, etc. and location)
Proposed Use : For Reference Spec's Item No.
FINE AGGREGATE
COARSE AGGREGATE
1. Container + Wet Soil, g 5,415.00
2. Container + Oven - Dried soil, g 5,350.00
3. Water, g (1) - (2) 65.00
4. Container, g 255.00
5. Dry soil, g (2) - (4) 5,095.00
6. Moisture Content, % (3) x 100
1.28
(5)
NOTED:
LEODEGARIO M. MAZO
Engineer III
Chief, Quality Assurance Section
R.13/12.6/qas/edc.
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
AGUSAN DEL SUR 2ND
DISTRICT ENGINEERING OFFICE
REGIONAL OFFICE XIII
San Francisco, Agusan del Sur
Project : 22NO0128 -
: 0
(Name) (Number) (City/Province)
Contractor : ###
Original Source : Simulao River Quarry, Sta. Maria, Trento, Agusan del Sur
(Pit, Quarry, River, etc. and location)
Sampled by : LILIBETH T. TIROL/GINA T. PAZ -Contractor Representative 30-Dec-1899
(Name and Designation) (Date)
Tested by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO
(Name and Designation) (Office) (Date)
Computed by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO
(Name and Designation) (Office) (Date)
Lab No. :
NOTED:
LEODEGARIO M. MAZO
Engineer III
Chief, Quality Assurance Section
R.13/12.6/qas/edc.
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
AGUSAN DEL SUR 2ND
DISTRICT ENGINEERING OFFICE
REGIONAL OFFICE XIII
San Francisco, Agusan del Sur
Project : 22NO0128 -
: 0
(Name) (Number) (City/Province)
Contractor : ###
Original Source : Simulao River Quarry, Sta. Maria, Trento & Sta. Josefa Quarry, Agusan del Sur
(Pit, Quarry, River, etc. and location)
Tested by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO
(Name and Designation) (Office) (Date)
Computed by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO 30-Dec-1899
(Name and Designation) (Office) (Date)
Lab No. :
NOTED:
LEODEGARIO M. MAZO
Engineer III
Chief, Quality Assurance Section
R.13/12.6/qas/edc.
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
AGUSAN DEL SUR 2ND
DISTRICT ENGINEERING OFFICE
REGIONAL OFFICE XIII
San Francisco, Agusan del Sur
Project : 22NO0128 -
: 0
(Name) (Number) (City Province)
Contractor : #NAME?
Kinds of Material : Coarse Aggregate Spec's/Item No. : 405
Sampled at : Jobsite
Original Source : Simulao River Quarry, Sta. Maria, Trento, Agusan del Sur
(Pit, quarry, river, etc and location)
Sampled by : LILIBETH T. TIROL/GINA T. PAZ -Contractor Representative 30-Dec-1899
(Name & Designation) (Date)
Tested by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO
(Name & Designation) (Office) (Date)
Computed by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO
(Name & Designation) (Office) (Date)
R.13/12.6/qas/edc.
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
AGUSAN DEL SUR 2ND
DISTRICT ENGINEERING OFFICE
REGIONAL OFFICE XIII
San Francisco, Agusan del Sur
Project : 22NO0128 -
: 0
(Name) (Number) (City Province)
Contractor : #NAME?
Kinds of Material : Fine Aggregate Spec's/Item No. : 0
Sampled at : Jobsite
(Give accurate location as possible)
Original Source : Sta. Josefa River Quarry, Sta. Josefa, Agusan del Sur
(Pit, quarry, river, etc and location)
Sampled by : LILIBETH T. TIROL/GINA T. PAZ -Contractor Representative 30-Dec-1899
(Name & Designation) (Date)
Tested by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO
(Name & Designation) (Office) (Date)
Computed by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO
(Name & Designation) (Office) (Date)
R.13/12.6/qas/edc.
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
AGUSAN DEL SUR 2ND
DISTRICT ENGINEERING OFFICE
REGIONAL OFFICE XIII
San Francisco, Agusan del Sur
Project : 22NO0128 -
: 0
(Name) (Number) (City Province)
Contractor : #NAME?
Original Source : Simulao River Quarry, Sta. Maria, Trento & Sta. Josefa Quarry, Agusan del Sur
(Pit, Quarry, River, etc. and location)
Tested by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO
(Name and Designation) (Office) (Date)
Computed by : Edna D. Curato - Laboratory Technician II DPWH ADS 2ND DEO
(Name and Designation) (Office) (Date)
Lab. No. :
NOTED:
LEODEGARIO M. MAZO
Engineer III
Chief, Quality Assurance Section
R.13/12.6/qas/edc.