UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY

College, Laguna

REQUEST FOR POURING NO. _________

Project : ________________________________________________________________________
Location : ________________________________________________________________________
Engineer : ________________________________________________________________________
Contractor : ________________________________________________________________________

_____________________
Date

S i r:

Permission is hereby requested to pour concrete for the

______________________________________________of the__________________________________________
(Structural Member) (Part of Structure)

from _______________________________________ to _________________________________________

(Date and Time) (Date and Time)

The estimated volume of concrete to be poured is _______________________________________ cubic meters

with fc’ 2,500 psi, 3,000 psi, 4,000 psi, 4,500 psi

Requested by:

___________________________
Contractor’s Project Engineer

The following work items have been checked and were found to conform to the plans and specifications:

ITEMS OF WORK DATE INSPECTED INSPECTED BY

1. Foundation excavation
2. Reinforcing bars
3. Form alignments
4. Embedded electrical items
5. Embedded plumbing items
6. Embedded mechanical items
7. Alignment of Architectural
Structures (i.e. true to line walls to
columns, etc.)
8. Others

APPROVED:

DR. MARLOE B. SUNDO

Chair, TWG

NOTE: Request for Pouring shall be submitted two (2) days before pouring schedule