Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88887 DEA: PC-Barrier-STOCK EFIS: PC-Barrier-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for precast barrier rail stock material.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-02-24-10
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 02/24/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/25/2026
The quantity of what the sample constitutes: 3 4x8 concrete cylinders
A brief description of the sample: 3 4x8 concrete cylinders
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ProCast Products, Sunol
The concrete mix design number: 3 4x8 concrete cylinders
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 02242026
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: 3 4x8 concrete cylinders
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
