Request for Admixture Chemical Test

Page of page(s) Castco LRN:

Sample details as supplied by customer will be shown on Report Quotation No.:

Customer: / Customer's Ref. No.:
Address:
Office Tel. No.: / Site Office Tel. No.: / Contact Person:
Job Title:
Contract No.: / Brand of Admixture:
Type of Admixture : / ☐ Acceleration / ☐ Retarding / ☐ Normal-Accelerating-Retarding / ☐ Water Reducing
☐ Superplasticizer / ☐ Waterproofing / ☐ Plasticizer agent
Sample I.D. No.: / Date Sampled:
Test Requested
Test Item / Test Method / Minimum Volume
of Sample Required
1.  Dry Material Content / BS 5075 : 1982(HOKLAS) / ☐ / EN 934-2 refer to BS EN 480-8(HOKLAS) / ☐ / 0.5 L
2.  Ash Content / BS 5075 : 1982(HOKLAS) / ☐
3.  Relative Density / BS 5075 : 1982(HOKLAS) / ☐ / EN 934-2 refer to ISO 758(HOKLAS) / ☐
4.  Chloride Ion Content (Cl-) / BS 5075 : 1982(HOKLAS) / ☐ / EN 934-2 refer to BS EN 480-10(HOKLAS) / ☐
5.  Sodium Oxide Content (Na2O) / In-house method(HOKLAS) / ☐ / EN 934-2 refer to BS EN 480-12(HOKLAS) / ☐
6.  Potassium Oxide Content (K2O) / In-house method(HOKLAS) / ☐ / EN 934-2 refer to BS EN 480-12(HOKLAS) / ☐
7.  Sulphate Content (SO3) / In-house method / ☐
8.  pH Value / EN 934-2 refer to ISO 4316(HOKLAS) / ☐
9.  Others / ☐
Note:
1. / Please tick "Ö" in the box of the test item required. / 2. / Test requests on other item or test method not listed above are also welcomed.
3. / Remaining samples (if any): For retrieve, please tick "Ö" in the right box, and retrieve within three months. Otherwise will be preserved by the laboratory for 3 months and then destroyed. / ☐
* / Please fill in note 4 or/and note 5 below if necessary, otherwise we assume below details same as above. (i.e. the test report and bill will be sent to address listed above)
4. / Please send the test reports to / Company Name:
Address:
5. / Please bill the test fee to / Company Name:
Address:
6. / Preliminary Result send to
Remark:
Customer’s Signature & Co. Chop.
Date:

Form No. CHM ADX REQ dd 25 05 2017

香港粉嶺安居街33號
香港粉嶺安全街29A號 / 33, On Kui Street, Fanling, Hong Kong.
29A, On Chuen Street, Fanling, Hong Kong. / Tel : 2597 8333
Fax : 2597 8399

E-mail: Website: www.castco.com.hk