Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215556 DEA: 081L6504 EFIS: 0820000131
QA Service Level: 1
DIST-CO-RTE-PM: 08--,58-
Work Description:
Location Description:
Contractor Name: FEC Future Contractors & Engineers, Inc
Contractor Address: 184 Technology Dr., Ste 2, Irvine, CA 92618
Resident Engineer: Larry Canuti Structure Rep.: Unknown
DIME Sample ID: 2021-10-08-27
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Quality Assurance
Type of Material: Rapid Set
Sample Taken Date: 10/08/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/08/2021
The quantity of what the sample constitutes: 130 CY
A brief description of the sample: 3 RSC beams
From where was the sample collected: Job Site
Laboratory sample identification: 100821-Set4
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Larry Francisco
