External Employee Independent Assurance Split Samples-Sieves/Gradation
Qualified Technicians are required to complete two independent assurance activities per test per year to maintain their qualifications. This form may be used to submit split samples.
Email *
Tech1 Name *
Tech1 WAQTC No *
Tech1 Employer *
Tech2 Name *
Tech2 WAQTC No *
Tech2 Employer *
IA Observer (Inspector) Name *
IA Observer (Inspector) WAQTC No *
IA Observer (Inspector) Employer *
Date of Test *
MM
/
DD
/
YYYY
Tech1: -200 by Washing *
Tech2: -200 by Washing *
Tech1: Passing 3/4 Sieve *
Tech2: Passing 3/4 Sieve *
Tech1: Passing 1/2 Sieve *
Tech2: Passing 1/2 Sieve *
Tech1: Passing 3/8 Sieve *
Tech2: Passing 3/8 Sieve
Tech1: Passing #4 Sieve *
Tech2: Passing #4 Sieve *
Tech1: Passing #8 Sieve *
Tech2: Passing #8 Sieve *
Tech1: Passing #16 Sieve *
Tech2: Passing #16 Sieve *
Tech1: Passing #50 Sieve *
Tech2: Passing #50 Sieve *
Tech1: Passing #200 Sieve *
Tech2: Passing #200 Sieve *
Submit
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