/ Application form / CONS/F-06

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APPLICATION FORM

– NOTIFICATION OF PARTICIPATION IN PROFICIENCY TESTING

BY INTERLABORATORY COMPARISONS

  1. Organizer of proficiencytesting

Organizer`s data (company name, address, telephone no): / PrzedsiębiorstwoGeologiczneSp. z o.o.
Anschrift: ul. Hauke Bosaka 3A, 25-214 Kielce/ Polen
Tel.: +48 41365 10 00, Fax:+48 41365 10 10
Contact person: / Krzysztof Wołowiec
Telephone no: / +48 41365 10 00, +48500074 479
e-mail: /
  1. Participant of proficiencytesting

Participant’s data (company name, address, telephone no):
Tax Identification Number:
Contact person:
Telephone no:
e-mail:
Accreditation no:
  1. Place to submit samples for tests

Company name, address:
Contact person:
Telephone no:
e-mail:
  1. E-mail to submit report

Contact person:
Telephone no:
e-mail:

CHOICE OF THE PROGRAM ROUND

CONSTRUCTION

Symbol of round / Object of tests / Propertytested1) / Starting date/Sample distribution date/ Date of sampling / Cost of participation / Confirmation of participation2)
1/CONS/18 / Aggregate / Assessment of fine particle content
Sand equivalent test
Fraction 0/4 mm / 21stFebruary, 2018 / 200,00 Euro
2/CONS/18 / Aggregate / Particleshape - Flakiness index / 28 thFebruary, 2018 / 200,00 Euro
3/CONS/18 / Aggregate / Particleshape - Shape index / 28 thFebruary, 2018 / 200,00 Euro
4/CONS/18 / Aggregate / Total sulfur content / 20 th March, 2018 / 200,00 Euro
5/CONS/18 / Aggregate / Determination of lightweight contaminations / 20 th March, 2018 / 200,00 Euro
6/CONS/18 / Soil / Areometricanalysis / 18 thApril, 2018 / 200,00 Euro
7/CONS/18 / Soil / Determination the limit liquidity of soil using Casagrande method and the yield strength of soil / 18 thApril, 2018 / 200,00 Euro
8/CONS/18 / Soil / Determination of the total specific surface area of the soil by adsorption of methylene blue / 18 thApril, 2018 / 200,00 Euro
9/CONS/18 / Aggregate / Loose bulk density and voids / 06 thJune, 2018 / 200,00 Euro
10/CONS/18 / Aggregate / Assessment of surface characteristics –
Flow coefficient of aggregates / 06 thJune, 2018 / 200,00 Euro
11/CONS/18 / Soil / Optimum moisture content and maximum dry density
of solid phase / 27 thJune, 2018 / 200,00 Euro
12/CONS/18 / Aggregate / Size distribution
Sieving method
Dust content / 11 thJuly, 2018 / 250,00 Euro
13/CONS/18 / Aggregate / Assessment of fines - Methylene blue test / 5 thSeptember, 2018 / 200,00 Euro
14/CONS/18 / Aggregate / Particle density of filler
Pyknometer method / 05 thSeptember, 2018 / 200,00 Euro
15/CONS/18 / Aggregate / Chemical tests of limestone
Content ofCaO, MgO, SiO2, Fe2O3, Al2O3
calculated on the dry mass / 26 thSeptember, 2018 / 300,00 Euro
16/CONS/18 / Natural stone / Determination of uniaxial compressive
strength / 24 thOctober, 2018 / 300,00 Euro
17/CONS/18 / Natural stone / Determination of apparentdensity / 24 thOctober, 2018 / 200,00 Euro

1) – Please choose the property to be tested by putting X in the column ,,Property tested”

2) – Please choose the program by putting X in the column ,,Confirmation of participation”

Invoices will be delivered with the object of tests.

Invoices shall be paid within 14 days from the date of issue.

The Participant declares that he has got acquainted with the description of the program and accepts conditions of participation.

Proficiency testing objects are delivered at the expense of the participant.

Ordering Party:
Date, Participantsignature
Edition no 2 dated 02-01-2018 / Page1 z 3