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BUILDING STANDARDS ADiNiNISTRATI~ )DE APPENDIX <br />(Part 1, Title 24, C.C.R.) <br />Appendix G <br />Sample of Laboratory verified Report <br />SAMPLE OF LABORATORY VERIFIED REPORT <br />Application Na <br />Affidaolt <br />TttE f3 To CltarrtrY, That all of our tests aad irnpectiott of materiah uad to <br />camtrttctloo of the <br />were made ra aooordanoe with the approved glom aad spedfintbm and the rule <br />and re6alatloos of the (irtlacetnant agency) and that aU were reported b <br />said department <br />AD the hob required by the approved glom and sped[iat-ans were made. <br />I certlfy (or deekus) uada peoaky of perjtvy flat I have read the above report <br />and krsow the eott~a the:cof; that a9 of the above sbtetneMs are true. <br />NORTHF]iN CAI.ffORMA TtsTtNC LAt10AA7'oRY <br />BY <br />Signature of duly authorized representative <br />No'r'E If all the test and itapectioru required by the approved plate and <br />speci4lntlons was ant made by the kdwratory making this affidavit. those which were <br />made should be caber (1? outlined m lieu of the lak sentence of the certificate a (2) <br />covered by referatce to a ktta of Imfructton or check list, frrnu the architect or <br />engineer, a Dopy of which ac~compmia fhb affidavit <br />35 <br />ZS of ~ 2 <br />