Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 8801 DEA: AML-CEM EFIS: AML-CEM
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for Cementitious Materials for use in Concrete Authorized Material List (AML)
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2012-12-12-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Cement Testing Laboratory
Sample Organization Contact: (916) 227-7071
Type of Sample: Annual Source Testing
Type of Material: Cementitious
Sample Taken Date: 12/12/2012
Date that the sample was received by the laboratory/organization performing the testing: 12/12/2012
The quantity of what the sample constitutes: 1 Bucket
A brief description of the sample: Type II Portland Cement
From where was the sample collected: Source
Laboratory sample identification: CM2454
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: XXXX
