Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66669 DEA: JMF-DATA EFIS: JMF-DATA
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for storing JMF sample data
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-07-11-86
TL Number from the TL Form:
Sample Submitted By Organization: Pyramid Construction and Aggregates
Sample Organization Contact: (760) 337-5839
Type of Sample: Quality Control
Type of Material: Antistrip Additive
Sample Taken Date: 07/11/2022
Date that the sample was received by the laboratory/organization performing the testing: 07/11/2022
The quantity of what the sample constitutes: 1 Gallons
A brief description of the sample: Lime
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Lhoist North America
