Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209950 DEA: 080N56U4 EFIS: 0813000176
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-R94.7/R99.7
Work Description: BRIDGE REPLACEMENTS.
Location Description: SAN BERNARDINO COUNTY NEAR ESSEX AT HALLER WASH BRIDGE AT ROJO WASH BRIDGE AND AT CLIPPER VALLEY WASH BRIDGE
Contractor Name: OHL USA, INC.
Contractor Address: 1920 MAIN STREET STE 310, Irvine, CA 92614
Resident Engineer: Darcy Davis Structure Rep.: Leonard Romero
DIME Sample ID: 2016-08-31-11
TL Number from the TL Form: 2016-06C
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 08/31/2016
Date that the sample was received by the laboratory/organization performing the testing: 09/06/2016
The quantity of what the sample constitutes: 2
A brief description of the sample: 6x12
From where was the sample collected: Job Site
Laboratory sample identification: 907-06C
Structure unique identifier: HALLER WASH
Structure name: ABUTMENT 2 FOOTING
The fabricator/manufacturer/facility name: robertsons
The concrete mix design number: rrm15027
The truck number from where the sample was collected: 1180
The batch plant ticket number from where the sample was collected: 2212915
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: load 14
Where the material sample would have been placed if not sampled: ABUTMENT 2 FOOTING
From Lot No.: Unknown
Bag Lot No.: Unknown
