GREEN BUILDING MATERIAL LEED DATA FORM

Project: Architect:
CSI Specification Section: Ready Mix Concrete Supplier / Sub contractor Concrete Masters, Inc. Contact : D. Dellosa Tel. No.: 837- 7777 Fax No. : 838-2208 www.

EEI Corp. - ADB Project

Concrete Masters, Inc. Concrete Masters, Inc. Jun D. Dellosa 837-7777 838-2208

Product: Manufacturer: Contact : Tel. No.: Fax No.: Jun

Product Certification
Tick applicable credit compliance and fill out the required information.

MR c4. 1 / 4.2 RECYCLED CONTENT

The product has a recycled content. Description of Recycled Content: Percentage of Post-Consumer (PO) Recycled Content (RC): Percentage of Pre-Consumer (PR) Recycled Content: Only a part of the assembly contains recycled content. Assembly Components w/ Description of RC: Weight % PO % PR

Totals by Quantity or Unit should be equal to 100% of assembly Assembly RC = [ Material Weight (lbs) x Recycled Content (%) / Total Weight (lbs) / 100%]
NB: For Concrete Subs Separate Submittal Data Sheets are required for cementitious materials in concrete (including Fly Ash). For All Subs Recycled content documentation must be attached. CSI Sections 14, 15, 16 and 27 are exempt from this credit.

MR c5. 1 / 5.2 REGIONAL MATERIALS

All components of the product were extracted, harvested or recovered (source i.e. mining site), as well as manufatured (i.e. plant) within 500 miles (800 km) of the project site. Harvest Location: Harvest Distance (Encircle unit used: mi / km) Manufacture Location: Manufacture Distance (Encircle unit used :

TAGUIG ,METRO MANILA

mi / km )
Green Building Material LEED Data Form

page 1 of 3

Form Development by Davis Langdon and Seah Phils. Inc. Do not reproduce without prior permission.

GREEN BUILDING MATERIAL LEED DATA FORM

EEI Corp. - ADB Project

Project: Architect:
CSI Specification Section: Ready Mix Concrete

Concrete Masters, Inc. Concrete Masters, Inc. Jun D. Dellosa 837-7777 838-2208

Product: Manufacturer: Contact : Tel. No.: Fax No.: Jun

Supplier / Sub contractor Concrete Masters, Inc. Contact : D. Dellosa Tel. No.: 837- 7777 Fax No. : 838-2208 www.

A portion of this product extracted, harvested or recovered ( source i.e. mining site), as well as manufactured (i.e. plant) within 500 miles (800 km) of the project site. Raw Materials Coarse Aggregate Fine Aggregate Cement Fly Ash City or Town / Province Angono, Rizal Florida Blanca, Pampanga Bulacan Quezon Province Distance (mi / km) Encircle unit used 50 120 50 180

NB: Verification letter from the manufacturer must be attached. Materials in CSI Sections 2 -10 contribute to this credit.

MR c7 CERTIFIED WOOD
The product has wood-based materials. The product is FSC certified. Component Chain-of-Custody (COC) Certificate No.

NB: Materials in CSI Section 2 10 contribute to this credit. COC Certified No. to come from the manufacturer if the product is FSC trademarked for this submittal. No. to come from the supplier / vendor if the product is not fabricated in a FSC certified plant.

CERTIFIED BY (Manufaturer): Print Name : Jun D. Dellosa

Signature : __________________________ Title : Technical Manager Date : _____________________________

Green Building Material LEED Data Form

page 2 of 3

Form Development by Davis Langdon and Seah Phils. Inc. Do not reproduce without prior permission.

GREEN BUILDING MATERIAL LEED DATA FORM

EEI Corp. - ADB Project

Project: Architect:
CSI Specification Section: Ready Mix Concrete

Concrete Masters, Inc. Concrete Masters, Inc. Jun D. Dellosa 837-7777 838-2208

Product: Manufacturer: Contact : Tel. No.: Fax No.: Jun

Supplier / Sub contractor Concrete Masters, Inc. Contact : D. Dellosa Tel. No.: 837- 7777 Fax No. : 838-2208 www.

Installer Certification
EQ c4 LOW EMITTING MATERIALS
The product is one of the following and used on the interior of the building (inside the weatherproofing system). Tick appropriate box and provide required information. Adhessive and Sealants VOC content g/L Paints and Coatings VOC content g/L Carpet Systems Backing Type CRI Identification No. Composite wood and Agrifiber product No Urea-formaldehyde resins Binder Type
NB: Refer to LEED Specificatios for allowable VOC limits for each product. Technical Data From the manufactrer must be attched. Materials In all CSI sections can contribute to this credit including MEPF.

CERTIFIED BY (Manufaturer): Print Name : Jun D. Dellosa Signature : __________________________ Title : Technical Manager Date : _____________________________

Cost Certification
Total Installed Material Cost (Less Labor and Equipment):

CERTIFIED BY (Manufaturer): Print Name : Jun D. Dellosa Signature : __________________________ Title : Technical Manager Date : _____________________________

Green Building Material LEED Data Form

page 3 of 3

Form Development by Davis Langdon and Seah Phils. Inc. Do not reproduce without prior permission.