Sample Record for 2021-07-21-40
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214114 DEA: 040A5394 EFIS: 0418000244
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-80,12-11.4/12.8, 2.1/2.8
Work Description: Widen EB SR-12 Connector, Construct 3 ramps & 2 box girder bridges, remove existing bridge, etc.
Location Description: I-80/I-680/Route 12 Interchange
Contractor Name: Kiewit Infrastructure West Co.
Contractor Address: 4650 Business Center Drive, Fairfield, CA 94534
Resident Engineer: Cassaundra Lograsso Structure Rep.: Kambiz Kouchesfahani
Sample Information
DIME Sample ID: 2021-07-21-40
TL Number from the TL Form:
Sample Submitted By Organization: Construction Testing Services
Sample Organization Contact: (925) 351-6905
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 07/21/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/22/2021
The quantity of what the sample constitutes: 325 CY
A brief description of the sample: 6x12 concrete cylinders (Set 1 of 4)
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Cordelia
Material Information
The concrete mix design number: 1619340
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 29755368
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Back of Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
