PMENT DATA, MATERIAL SAMPLES, OR
MANUFACTURER'S CERTIFICATES OF COMPLIANCE
(Read instructions on the reverse side prior to initiating this form)
SECTION I - REQUEST FOR APPROVAL OF THE FOLLOWING ITEMS
(This section will be initiated by the contractor)
TRANSMITTAL NO.

NAME, TITLE AND SIGNATURE OF APPROVING AUTHORITY
DATE
SECTION II - APPROVAL ACTION
ITEM
NO.
a.
DESCRIPTION OF ITEM SUBMITTED
(Type size, model number/etc.)
b.
MFG OR CONTR.
CAT., CURVE
DRAWING OR
BROCHURE NO.
(See instruction no. 8)
c.
NO.
OF
COPIES
d.
SPEC.
PARA. NO.
e.
DRAWING
SHEET NO.
f.
FOR
CONTRACTOR
USE CODE
g.
VARIATION
(See
instruction
No. 6)
h.
FOR
CE
USE
CODE
i.
NAME AND SIGNATURE OF CONTRACTOR
ENG FORM 4025-R, MAR 95
(Proponent: CEMP-CE)
EDITION OF SEP 93 IS OBSOLETE.
(ER 415-1-10)
CHECK ONE: THIS TRANSMITTAL IS
FOR FIO GOV'T. APPROVAL