Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 7285 DEA: 040120T4 EFIS: 0400000027
QA Service Level: 1
DIST-CO-RTE-PM: 04-SF-80-12.6/13.9
Work Description: CONSTRUCT BRIDGE, ROADWAYS, ELECTRICAL, BUILDINGS AND REMOVE BRIDGES
Location Description: THE CITY AND COUNTY OF SAN FRANCISCO FROM THE YERBA BUENA TUNNEL TO 1.3 KM EAST OF THE YERBA BUENA TUNNEL
Contractor Name: CALIFORNIA ENGINEERING CONTRACTORS, INC.
Contractor Address: 20 HAPPY VALLEY ROAD, PLEASANTON, CA 94566
Resident Engineer: Tom Larwin Structure Rep.: Mehran Ardakanian
DIME Sample ID: 2015-07-13-13
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Oakland (YBITS2) Field Laboratory
Sample Organization Contact: (510) 286-4247
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 07/13/2015
Date that the sample was received by the laboratory/organization performing the testing: 08/06/2015
The quantity of what the sample constitutes: 2 cyliners
A brief description of the sample: Abutment 11 Wall
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: Abutment 11 Wall
Structure name: EB Onramp
The fabricator/manufacturer/facility name: Central
The concrete mix design number: D101C5E1
The truck number from where the sample was collected: 1215
The batch plant ticket number from where the sample was collected: 18050237
Concrete batch plant: 12
The fabricator/manufacturer designation for the sample: MCM Construction
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.:
