Sample Record for 2024-09-03-99
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995524 DEA: 021H3604 EFIS: 0216000040
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-76.8/78.0
Work Description: REPLACE BRIDGE.
Location Description: SISKIYOU COUNTY NEAR HORSE CREEK FROM 0.4 MILE WEST OF KLAMATH RIVER BRIDGE TO 2.0 MILES WEST OF KOHL CREEK
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Nicholas Riddle Structure Rep.: Mike Sears
Sample Information
DIME Sample ID: 2024-09-03-99
TL Number from the TL Form:
Sample Submitted By Organization: Myers and Sons Construction
Sample Organization Contact: (650) 864-2057
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 09/03/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/03/2024
The quantity of what the sample constitutes: 27.5 CY
A brief description of the sample: Aggregate for Concrete Mix used in Bridge CIDHS
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Abutment no. 4
The fabricator/manufacturer/facility name: Moores Sand and Gravel
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-45-0043
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number: MYERS AND SONS
A detailed description of where the material sample was collected: Onsite Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number: KCIDH
Test Results
