DIPARTIMENTO DI INGEGNERIA CIVILE, EDILE E AMBIENTALE - ICEA LABORATORIO SPERIMENTALE PER LE PROVE SUI MATERIALI DA COSTRUZIONE Via Marzolo, 11/A – 35131 PADOVA Tel. 049 827 5607 – Fax 049 827 5587 – e-mail: [email protected] (spazio riservato alla Segreteria) commessa _________________________ ALLEGATO A3 protocollo _________________________ PROVE STRUTTURALI DI LABORATORIO data di protocollo ___________________ Descrizione del materiale da provare: _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Prove richieste: _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Prove da eseguirsi secondo la seguente normativa di riferimento: _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Modalità di prova non normate ed indicate dallo scrivente mediante allegati forniti o contatti con la Direzione del Laboratorio. Timbro e firma del Direttore dei Lavori (se richiesta o prevista ai sensi del D.M. 14/01/2008 Min. II.TT.) Firma del Richiedente _______________________________ ________________________________