Form : GRS-1001-ENG-CHK-005 MARTABE GOLD PROJECT EMK

Issue : SECONDARY CRUSHER

PT. EPITERMA MAS KONSTRUKSI
Date : GROUTING CUBE TEST RECORD

Area :
Section :
Element :

Test Result

Cube No. has to Specified Dial Measured

Age Weight Density Percentage
be Delivery Date Casted Date Tested Strength Reading Strength
(days) (gram) (kg/m3) (%)
Docket No. (Mpa) (kN) (MPa)

Test Conducted by Laboratory :

PT. EMK : Signature: ……………………

……………… Date: …………. ………….

PTAR QA/QC : Signature: ……………………

……………… Date: …………. ………….

Comments
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Witnessed Name Signature Date Result Remarks

PT. EMK

PTAR QA/QC

*Result A: Passed B: Passed subject to Observation C: Non-Conforming D: Not Applicable