JOB NO:
REPORT NO:
MATERIAL TESTING CONSIGNMENT NOTE
Company : Date :
Report Issued To : Quantity of Sample Sent :
Project :
To carry-out Material Testing as follows :-
1. Tensile Test : (Longitudinal / Transverse / Z-Direction / All Weld / Rebar / Rebar Coupler / Bolt)
2. Proof Load Test : (Bolt/ Nut)
3. Shear Test : Overlay Bolt Others
4. Bend Test : Face Root Side
5. Hardness Test : HV HBW HRC Location: Cross-sectional / Surface
6. Charpy Impact Test : BM WM HAZ FL FL + 1 FL + 2 FL+5
Test Temperature : C
7. Macro Etch : 8. Nick Break / Fracture Test :
9. Rebend Test (Rebar/BRC) : 10. Fatigue Test (Rebar/Rebar Coupler) :
11. Flattening Test : 12. Flaring / Drift / Ring- Expanding Test :
13. Microstructure Test : 14. Grain Size ASTM E112 :
15. Ferrite Count : Manual ASTM E 562 Ferritscope Test
(Microscope) (Portable Machine)
16. Corrosion Test : ASTM G 48 (A) ASTM A 262 (A / B / E) ISO 3651-2 ASTM A923 (C)
17. Chemical Analysis : Spectrometer XRF Elements:
18. PWHT : (Please fill up the PWHT Form)
19. NDT : i. RT : X-Ray Gamma Ray Film :
: ii. DPT iii. MPI iv. UT
20. Others Testing (Please Specify) : 21. Witness By (if any) :
22. Raw Material Sample Details 23. Welded Sample Details
a) Sample Description : a) WPS No. / PQR No. :
b) Heat No. / Sample ID : b) Sample Description :
c) Part Name / No. : c) Material Spec. /Grade :
d) Material Spec. / Grade : d) Size (Thk./ Dia.) :
e) Size (Thk./ Dia.) : e) Weld Type/ Joint Design :
f) Test Spec/ Method : f) Weld Position/ Process :
g) Welder’s Name :
h) IC No. / Welder No. :
i) Test Spec / Method :
NOTE : Customer shall be responsible to collect the remaining test sample/s within 14 days after completion of testing otherwise it shall be
disposed of without notice. Nusatek reserve the right not to amend/ include any additional information not furnished in this form after
the official test report has been issued to the customer.
REQUESTED BY : (Customer) RECEIVED BY : (NUSATEK)
Signature : Signature :
Name : Name / Date :
Contact No. / Email : Sample condition : Good / Rusty / Dented / Chipped /___________
FRM2-007 3rd January 2022 REV 03
NUSANTARA TECHNOLOGIES SDN. BHD. 198901010451(187753-D)
Head Office & Material Division: No. 5, Jalan Anggerik Mokara 31/45, Seksyen 31, Kota Kemuning, 40460 Shah Alam, Selangor Darul Ehsan, Malaysia. Tel: 603-5122 9766/7/8 Fax: 603-5122 8766/7
Metrology & NDT Division: No. 9, Jalan Sungai Jerluh 32/196, Seksyen 32, Bukit Kemuning, 40460 Shah Alam, Selangor Darul Ehsan, Malaysia. Tel: 603-5525 1766 Fax: 603-5525 2766
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