Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
DEA: No Project
QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2024-09-09-135
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 09/09/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/04/2024
The quantity of what the sample constitutes: 27.5
A brief description of the sample: Column
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Pile #1, Abutment 4
The fabricator/manufacturer/facility name: Myers and Sons Construction
The concrete mix design number: KCIDH
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 12345
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete truck Chute
Where the material sample would have been placed if not sampled:
From Lot No.: 1
Bag Lot No.: 1
DIME Test ID: 2024-09-09-135-2
Test Method: ASTM C39-21: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Submitted By Organization: CT HQ - QASI Sacramento Field Office
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: seyedhamed.sadati@dot.ca.gov
Organization Phone: (916) 205-8871
Data has not been verified.
