Ad Hoc Request Form _FM-RA-02__rev10-14_

Ad Hoc Request Form for G200 Recycled Rockfill
(Please see notes below before filling the Form.)
To : Chief Engineer/Fill Management, CEDD
Contract No. :
Fax : 2623 9122 - Tseung Kwan O
Department :
Contract Title :
Contact Person :
Signature of Supervisory Staff :
Tel :
Fax :
Email :
Requested Quantity of
G200 Recycled
Rockfill (tonnes)
Place of Collection :
Name / Rank :
Collection Date
(1 day only)
Tel :
Fax :
Date :
Accepted quantity
(for official use)
Tseung Kwan O Fill Bank
* Please indicate the application of material with number:
1. Granular filling Material;
2. Drainage;
4. Filter;
5. Others (Please specify).
3. Hardcore;
Please tick in the appropriate boxes for the requested material(s) with regard to :
1. Usage
□ Permanent works
□ Temporary works
2. Type of collection
□ Barge
□ Truck
-----------------------------------------<<For official use>>------------------------------------------Ad Hoc Request Serial No. :
Name of Officer :
Signature :
Date :
---------<<Collection information to be completed by customer for accepted order>>------1. Please bear this Form or its photocopy for collection of materials
upon arrival at Fill Bank. One copy is required for each vehicle.
Please indicate vehicle registration number in the box to the right.
2. This Form or its photocopy must be stamped with an authorised
chop of the Engineer’s/Architect’s Representative and signed by the
supervisory staff (same as the above).
3. A computer printout will be issued to the bearer of this form upon
delivery of the materials to record the collection data.
FM-RA-02 (Revised 10/14)
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Mark of a
(vehicle registration no.)
(Signature of Supervisory
Staff – same as the above)
Notes :
1. This Form is for ad hoc request of G200 recycled rockfill from the Fill Bank managed
by the Fill Management Division of CEDD. For advance ordering materials, another
Form entitled “Advance Order Form for G200 Recycled Rockfill” is to be used.
2. One Form is to be used for materials to be collected on one particular day only.
Separate Forms have to be used for ad hoc request for ordering requiring more than one
collection day.
3. The Form shall be produced to Fill Bank supervisory team on the collection date.
verbal reservation of materials will be entertained.
4. For ad hoc request, no land transport for hauling within the Fill Bank Site will be
provided hence collection by barge is not viable.
FM-RA-02 (Revised 10/14)
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