Address: Bridgestone India Private Limited

Plot No. A43 Phase-II, MIDC Chakan, Village Sawardari,

Taluka Khed, Dist. Pune Maharashtra-410501

TEST REQUEST FORM

Doc No. BSIDp-F-QA-C-915
Rev. no. 01
Rev. Date 25/02/2022
Cutomer/Requester Details
Request Section/Dept.
Requester Name
Contact Details
Organisation
Requester Approved
Name
Designation
Signature
Product Test Lab (Quality Assurance)
Test Request Review Yes/No/NA Remarks
The requirements are adequately defined, documented and understood?
The laboratory has the capability and resources to meet the requirements?
Subcontracting activities are required or not?
The appropriate methods or procedures are selected and are capable of meeting the customers' requirements?
Whether Statement of conformity is required or not?
Approved by
Name
Designation Lab Incharge
Signature
PE LAB
TIRE SIZE
PRODUCTION CODE
SAMPLE QUANTITY
PURPOSE OF TESTING
REASON/BACKGROUND
CONTENTS OF REQUEST TESTING
TEST NAME YES BAR CODE NO. Test Method Std. LAB COMMENTS REMARKS
FOOT PRINT Not in Lab Scope
DIMENSION(OD,OW,TWI)
PLUNGER ENERGY Not in Lab Scope
BEAD UNSEATING Not in Lab Scope
CUT ANALYSIS Not in Lab Scope
RRC (ROLLING RESISTANCE COEFFICIENT TEST
LOAD/SPEED PERFORMANCE TEST
ENDURANCE TEST
CBU DRUM Not in Lab Scope
BF DRUM Not in Lab Scope
Regulation ECE R30 Dimension
Regulation ECE R30 Load/speed Endurance
Regulation ECE R54 Dimension
Regulation ECE R54 Load/speed Endurance
Regulation ECE R54 Endurance
OTHER REQUEST ITEMS
1)
2)
3)
4)
5)
TIRE SUBMISSION DATE
PRIORITY
EXPECTED TEST COMPLETION (DATE / TIME)
MASTER PROCESS NO.(IN CASE OF ANY SPECIAL REQ.)
RESPONSIBLE PERSON

Note:

1) Please fill Annexure F in case of RRC test request

2) Please collect tested tires after any requested testing.

3) In case of any special condition ,please provide test condition & testing Method