Sample Record for 2024-01-05-27
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994109 DEA: 060W1704 EFIS: 0617000103
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-41-R27.4/R28.5
Work Description: REMOVE AC PAVEMENT, WIDEN TRAVEL WAY, AND CONSTRUCT RETAINING WALL.
Location Description: FRESNO COUNTY IN FRESNO FROM 0.1 MILE SOUTH OF ASHLAN AVENUE OVERCROSSING TO SHAW AVENUE OVERCROSSING
Contractor Name: RNR Construction, Inc
Contractor Address: 8589 Thys Court, Sacramento, CA,95828
Resident Engineer: Mark Mengoni Structure Rep.: Benjamin Holton
Sample Information
DIME Sample ID: 2024-01-05-27
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 01/05/2024
Date that the sample was received by the laboratory/organization performing the testing: 01/08/2024
The quantity of what the sample constitutes: 300
A brief description of the sample: PCC cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Ground Anchor Wall 3
The fabricator/manufacturer/facility name: Builders Concrete Ready Mix Plant Sanger
Material Information
The concrete mix design number: ND22023
The truck number from where the sample was collected: 4
The batch plant ticket number from where the sample was collected: 111335822
Concrete batch plant: Builders Concrete
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Wall 3 Wall Facing Station 33+50 to 36+15
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
