Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
DEA: No Project
QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2019-06-03-10
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Preliminary
Type of Material: Soil
Sample Taken Date: 06/03/2019
Date that the sample was received by the laboratory/organization performing the testing: 06/05/2019
The quantity of what the sample constitutes: ample
A brief description of the sample: bulk soil sample
From where was the sample collected: Source
Laboratory sample identification: 19-083
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Native soil
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Unknown
Where the material sample would have been placed if not sampled: Unknown
