Sample Record for 2024-03-24-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994686 DEA: 051K4604 EFIS: 0518000210
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-46-29.7/32.2
Work Description: COLD PLANE, PLACE HMA, RHMA, CONC PVMT, MODIFY SIGNAL AND LIGHTING.
Location Description: SAN LUIS OBISPO COUNTY IN PASO ROBLES FROM 300 FEET WEST OF ROUTE 101/46 SEPARATION TO 0.1 MILE EAST OF AIRPORT ROAD
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: 800 FARROLL RD, GROVER BEACH, CA 93433
Resident Engineer: Michael Schmidt Structure Rep.: Ray Barajas
Sample Information
DIME Sample ID: 2024-03-24-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Paso Robles Field Laboratory
Sample Organization Contact: 1 (209) 610-9363
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 03/24/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: barrier walls through job limits
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 240324
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CalPortland Paso Robles
Material Information
The concrete mix design number: 590RN1010
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 1960640
Concrete batch plant: Calportland
The fabricator/manufacturer designation for the sample: mix
A detailed description of where the material sample was collected: Back of truck chute
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
