Construction Materials Testing Info Form

P.O. BOX 60791 • HOUSTON, TEXAS 77205
TEL: (281) 441-1462 • FAX: (281) 441-2367 • EMAIL: info@lshtesting.com
CONSTRUCTION MATERIALS TESTING INFORMATION FORM
Date:

MonthDayYear
LSH Job#:
To be filled out by LSH
Project Name:
Project Address:
Key Map# :
Brief Description of Project:
Directions to Site:
Permitting Authority:
Permit #:
Permitting Authority Special Inspection Requirements:
Test in accordance with:

project plans/specs (copies required)other
File Upload

Cancelof
Note: Where not otherwise specified, default tests and quantities will be utilized and test results will not be compared to project requirements.Tests performed in this manner may not meet project requirements.
SERVICES REQUESTED
SERVICES REQUESTED (Check all that apply):

Proof-rollCompaction -FillReinf. SteelPavementAsphaltCompaction-Subg.Pier InspectionConcreteBaseUtilitiesOther
LSH Client Information:
Name:
Address:
Phone #:
Fax #:
Email:
example@example.com
Purchase Order #:
Special Invoicing Requirements:
Companies/Persons Authorized To Schedule Services
Report Distribution List:

ClientGeneral ContractorArchitectS. Engr.Other
(Please provide addresses, emails and/or fax numbers)
General Contractor:
Architect:
Structural Engineer:
Completed by:
Date:

MonthDayYear
Date
LSH Project Documents:

to be filled out by LSH
Received Copies of :

Structural DrawingsPlansSpecsOther
Should be Empty: