Sample Record

Owner Lab

  • CT HQ - QASI Sacramento Field Office

DIME Sample ID 2022-04-13-13

Project Information

Project IdentifiersProject ID: 215063
DEA: 032F5704
EFIS: 0300020615
DIST-CO-RTE-PM03-PLA-80-46.3/63.5
Award Date09/23/2020
Closeout Date08/11/2023
Work DescriptionReplace 4 Bridges (OC) on Highway 80 from Crystal Springs to Cisco Grove (Baxter, Drum Forebay)
Location DescriptionNot set
QA Service Level1 (Verified on 11/16/2020)

Sample Information

Sample Taken Date04/13/2022 Sample Unique Key13
Date that the sample was received by the laboratory/organization performing the testing04/14/2022 Sample typeQuality Assurance
A brief description of the sample4x8 concrete cylinders The quantity of what the sample constitutes6 x (4" x 8") cylinders
From where was the sample collectedFabricator First name of sampler or witnessed byChristopher
Last name of sampler or witnessed byNutting Title of samplerQuality Assurance Inspector
Telephone number of sampler6469510671 Laboratory sample identification
Linked DIME Sample ID The fabricator/manufacturer/facility nameKie-Con Antioch
Transportation Laboratory (TL) Number Inspector Lot Number from the Transportation Laboratory (TL) Form
Structure unique identifier31-19-0207 Structure nameReplace 4 Bridges from Crystal Springs to Cisco Grove
Bid ItemNot set

Material Information

Material TypeConcrete The concrete mix design numberK5670-100 CpR6
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected114327
Concrete batch plantKieCon The fabricator/manufacturer designation for the sampleMix
A detailed description of where the material sample was collectedConcrete sample from wheelbarrow Where the material sample would have been placed if not sampledprecast girder
From Lot No.load id 115440 Bag Lot No.

Submitted Tests

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