Sample Record for 2023-05-22-73
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994812 DEA: 042K7204 EFIS: 0417000014
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-4-R14.3/24.3
Work Description: Pvmt rehabilitation, slab repl, ADA curb ramp and install guardrail.
Location Description: On state highway in Contra Costa County in and near Concord and Pittsburg from 0.3 miles east of Peralta Road Undercrossing to Loveridge Road Overcrossing.
Contractor Name: O.C. Jones & Sons, Inc. (Victor Babbitt)
Contractor Address: 1520 Fourth Street, Berkeley, CA 94710
Resident Engineer: Rabi Mukherjee Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2023-05-22-73
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/22/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2023
The quantity of what the sample constitutes: 3 beams
A brief description of the sample: PCC Beams
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vanguard / G3
Material Information
The concrete mix design number: HE4X4BM
The truck number from where the sample was collected: 0000
The batch plant ticket number from where the sample was collected: 0000
Concrete batch plant: Vanguard
The fabricator/manufacturer designation for the sample: 1
A detailed description of where the material sample was collected: Concrete Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
