Sample Record for 2023-07-10-40
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993312 DEA: 030J7004 EFIS: 0320000004
QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-32-30.8/31.0
Work Description: CONSTRUCT RETAINING WALL, CULVERT AND PLACE HMA.
Location Description: BUTTE COUNTY NEAR FOREST RANCH FROM 1.3 MILES SOUTH TO 1.1 MILES SOUTH OF CARPENTER RIDGE ROAD
Contractor Name: Steelhead Constructors, Inc
Contractor Address: 2490 Innsbruck Dr, Redding, CA 96003
Resident Engineer: Daniel Rechs Structure Rep.: Adam Scardaci
Sample Information
DIME Sample ID: 2023-07-10-40
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Chico Field Laboratory
Sample Organization Contact: (916) 799-4305
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 07/10/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/13/2023
The quantity of what the sample constitutes: 300 cu yds
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 23-120
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mathews Readymix
Material Information
The concrete mix design number: 07215PA15
The truck number from where the sample was collected: 0805
The batch plant ticket number from where the sample was collected: 17023528
Concrete batch plant: Mathews Readymix Oroville
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Waler 2C
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
