Sample Record for 2024-08-19-108
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994859 DEA: 021H5904 EFIS: 0216000025
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-43.5,57.0
Work Description: REPLACE CULVERTS WITH BRIDGES, STREAMBED RESTORATION, & LANDSCAPING.
Location Description: SISKIYOU COUNTY AT AND NEAR HAPPY CAMP AT 0.8 MILE WEST OF GORDON\\'S FERRY ROAD AND AT PORTUGUESE CREEK
Contractor Name: J.F. SHEA CONSTRUCTION, INC.
Contractor Address: 17400 CLEAR CREEK ROAD, REDDING, CA 96001
Resident Engineer: Nicholas Riddle Structure Rep.: Nicolas Jimenez
Sample Information
DIME Sample ID: 2024-08-19-108
TL Number from the TL Form:
Sample Submitted By Organization: Kie-Con, Incorporated - Antioch
Sample Organization Contact: (925) 331-7122
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 08/19/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/19/2024
The quantity of what the sample constitutes: 27 CY
A brief description of the sample: QC aggregate sampling
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: KIE- CON
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-07-0003
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: K5065-23137
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
