Sample Record for 2025-07-30-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000563 DEA: 021H7104 EFIS: 0217000013
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-3,5-L47.4,R45.5/R46.0
Work Description: NEW MECHANIC SHOP AT YREKA MAINTENANCE STATION.
Location Description: SISKIYOU COUNTY IN YREKA ON ROUTE 3 AT YREKA MAINTENANCE STATION AND ON ROUTE 5 FROM 0.2 MILE SOUTH TO 0.4 MILE NORTH OF SOUTH YREKA UNDERCROSSING #02-0159
Contractor Name: MCCUEN CONSTRUCTION, INC.
Contractor Address: 3269 Swetzer Road, Loomis, CA 95650
Resident Engineer: Henry Austin Structure Rep.: Carlos Paz
Sample Information
DIME Sample ID: 2025-07-30-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Quality Control
Type of Material: Precast Concrete
Sample Taken Date: 07/30/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: Test
A brief description of the sample: test
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: test
Material Information
The concrete mix design number: test
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: test
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: tset
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
