Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001386 DEA: 072XT404 EFIS: 0725000225
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-LA-710-194.0
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Shahnam Shahriari Structure Rep.: Unknown
DIME Sample ID: 2025-01-31-49
TL Number from the TL Form: 000001
Sample Submitted By Organization: Future Labs, LLC
Sample Organization Contact:
Type of Sample: Quality Assurance
Type of Material: Rapid Set
Sample Taken Date: 01/31/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/30/2025
The quantity of what the sample constitutes: 55 lb. bag
A brief description of the sample: Rapid set
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CTS Cement Manufacturing Corp.
