Sample Record for 2023-07-14-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994309 DEA: 033H5404 EFIS: 0318000012
QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-70-46.0/47.0
Work Description: RAISE ALIGNMENT, PLACE HMA, STRUCTURAL CONCRETE & BRIDGE RAIL.
Location Description: BUTTE COUNTY NEAR PARADISE FROM 0.8 MILE WEST OF SHADY REST AREA TO 0.2 MILE EAST OF SHADY REST AREA
Contractor Name: VIKING CONSTRUCTION COMPANY, INC.
Contractor Address: 11315 SUNRISE GOLD CIR. #A, RANCHO CORDOVA CA 95742
Resident Engineer: Daniel Rechs Structure Rep.: Adam Scardaci
Sample Information
DIME Sample ID: 2023-07-14-6
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Chico Field Laboratory
Sample Organization Contact: (916) 799-4305
Type of Sample: Preliminary
Type of Material: Concrete
Sample Taken Date: 07/14/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/15/2023
The quantity of what the sample constitutes: Trial Batch
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Supplier
Laboratory sample identification: 23-121
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mathews Readymix
Material Information
The concrete mix design number: G72157PA
The truck number from where the sample was collected: 724
The batch plant ticket number from where the sample was collected: 365432
Concrete batch plant: Mathews Readymix Oroville
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Chute
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
