Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 77777 DEA: CHEM-STOCK EFIS: CHEM-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for Chem Lab stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-06-06-42
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Chemistry Laboratory
Sample Organization Contact: (916) 227-7912
Type of Sample: Quality Assurance
Type of Material: Glass Beads
Sample Taken Date: 06/06/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/20/2025
The quantity of what the sample constitutes: (2) 1 qt cans
A brief description of the sample: GLASS BEADS M247-13 TYPE 2
From where was the sample collected: Manufacturer
Laboratory sample identification: C251010
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Potters Industry
