Sample Record for 2015-06-11-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 208862 DEA: 080K7104 EFIS: 0800000366
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15,215-14.0/R16.4,16.0/17.8
Work Description: I-15/I-215 Interchange Improvements (Devore)
Location Description: On I-15 from 0.8 mile south of Glen Helen Parkway UC to 1.4 mile north of Kenwood Ave UC And On I-215 from 1.2 mile south of Devore Road OC to the I-15 junction
Contractor Name: Atkinson Construction,, LLC
Contractor Address: 1672 Devore Road, San Bernardino, CA 92407
Resident Engineer: Owen Spencer Structure Rep.: Scott Gueltzow
Sample Information
DIME Sample ID: 2015-06-11-3
TL Number from the TL Form: 180600
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 06/11/2015
Date that the sample was received by the laboratory/organization performing the testing: 06/15/2015
The quantity of what the sample constitutes: 2
A brief description of the sample: 6x12
From where was the sample collected: Job Site
Laboratory sample identification: 868-00
Structure unique identifier: bridges 4 and 5
Structure name: interrior abutment diaphragms
The fabricator/manufacturer/facility name: job
Material Information
The concrete mix design number: cm5800
The truck number from where the sample was collected: 219
The batch plant ticket number from where the sample was collected: 103035866
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: chute
Where the material sample would have been placed if not sampled: Unknown
From Lot No.:
Bag Lot No.:
Test Results
Tests Assigned to this Sample
| DIME Test ID | Test Method | Assigned Date | Test Date | Assigned By | Assigned Lab | Test Comments | Assigned To |
| 2015-06-11-3-1 | CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders | 06/12/2015 | 07/23/2015 | Matthew Clayton | CT D08 - Fontana Southern Regional Laboratory | 42 days | |
2163
