Sample Record for 2018-03-06-15
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213337 DEA: 024F5404 EFIS: 0213000004
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-5-R15.3/R16.5
Work Description: BRIDGE REPLACEMENT - SOUTHBOUND ONLY
Location Description: SISKIYOU COUNTY NEAR WEED FROM 0.1 MILE SOUTH OF DEETZ ROAD UNDERCROSSING TO 0.6 MILE NORTH OF BLACK BUTTE OVERHEAD 02-0004L
Contractor Name: J.F. SHEA CONSTRUCTION
Contractor Address: P.O. BOX 494519, REDDING, CA 96049-4519
Resident Engineer: Jeff Steppat Structure Rep.: Andy O'Sullivan
Sample Information
DIME Sample ID: 2018-03-06-15
TL Number from the TL Form: Unknown
Sample Submitted By Organization: Sousa Ready Mix, LLC
Sample Organization Contact: (530) 926-4485
Type of Sample: Informational
Type of Material: Aggregate
Sample Taken Date: 03/06/2018
Date that the sample was received by the laboratory/organization performing the testing: 03/06/2018
The quantity of what the sample constitutes: 200 lbs
A brief description of the sample: 1x#4 Concrete Aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sousa Ready Mix, LLC
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-47-0015
The fabricator's/manufacturer's product name for the sample: 1 inch Rock
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Unknown
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: Unknown
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
