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Sample Record for 2017-03-15-9

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 211997 DEA: 044K1504 EFIS: 0417000271 COOP: 250 QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-1-4.0/8.0
Work Description: const SPW and replace culvert
Location Description:
Contractor Name: Maggiora & Ghilotti
Contractor Address: 555 Dubois Street, San Rafael, CA 94901
Resident Engineer: Steve Russell Structure Rep.: Janine Marr

Sample Information

DIME Sample ID: 2017-03-15-9
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT SC Sub-unit 3672-105
Sample Organization Contact:
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 03/15/2017
Date that the sample was received by the laboratory/organization performing the testing: 04/03/2017
The quantity of what the sample constitutes: 30 CY
A brief description of the sample: 2 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: Shamrock

Material Information

The concrete mix design number: 4201A
The truck number from where the sample was collected: 1298
The batch plant ticket number from where the sample was collected: 152103
Concrete batch plant: 01
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: CHUTE FROM TRUCK
Where the material sample would have been placed if not sampled: soldier pile wall
From Lot No.: Unknown
Bag Lot No.: Unknown

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.