FOEMS FOR SPECIFICATIONS, ETC., FOR ROAD MATERIALS. 39 



(Name and location of laboratory :) 



Report on Sample of Gbavel or Sand. 



Laboratory No. 



Name. 



191__. 



(Date reported.) 



Identification marks 



Submitted by Title Address 



Sampled , 191 Received , 191. 



Sampled from 



Quantity represented 



Source of material - — 



Location used or to be used 



Examined for 



TEST RESULTS. 



Sand. 

 Mechanical analysis. 



Gravel. 

 Mechanical analysis. 



Fraction. 



Per cent. 



Fraction. 



Per cent. 















































































Total 







1 

 











Total 



. . 1 





















Tensile strength (cement-sand 



Sample sand. 



Standard Ottawa sand. 



briquettes, 1:3). 



3-day. 



7-day. 



28-day. 



3-day. 



7-day. 



28-day. 



1 















2 















3 















4 















5 

































































1 











Remarks ; 



Respectfully submitted, 



(Title). 



