Sample Record for 2017-05-11-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 9999 DEA: 00000000 EFIS: 0000000000 COOP: 99999333399 MINOR: 333333 Permit Numbers: 555555 0400NRT0000
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: YYZ
Contractor Address: 1234 address, Sacramento, CA 95824
Resident Engineer: RE_first RE_last Structure Rep.: SR_First SR_Last
Sample Information
DIME Sample ID: 2017-05-11-2
TL Number from the TL Form: Unknown
Sample Submitted By Organization: ZZCT DIME Development Laboratory A - Bellflower - Internal
Sample Organization Contact: (213) 555-1212
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 05/11/2017
Date that the sample was received by the laboratory/organization performing the testing: 05/11/2017
The quantity of what the sample constitutes: 100 cy
A brief description of the sample: Precast concrete
From where was the sample collected: Manufacturer
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: Forterra
Material Information
The concrete mix design number: 123456
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: 12345677
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: wheelbarrow
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
Test Results
Test 1 of 2
DIME Test ID: 2017-05-11-2-1
Test Method: ASTM C143-15a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 05/11/2017
Date Tested: 05/11/2017
Submitted By Organization: ZZCT DIME Development Laboratory A - Bellflower - Internal
Organization Address: 1234 Norwalk Boulevard,
Organization City: Bellflower
Organization State: CA
Organization Zipcode: 90725
Organization Email: test.user@dot.ca.gov
Organization Phone: (213) 555-1212
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Test 2 of 2
DIME Test ID: 2017-05-11-2-2
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C617/CTM521
Submitted By Organization: ZZCT DIME Development Laboratory A - Bellflower - Internal
Organization Address: 1234 Norwalk Boulevard,
Organization City: Bellflower
Organization State: CA
Organization Zipcode: 90725
Organization Email: test.user@dot.ca.gov
Organization Phone: (213) 555-1212
Data has not been verified.
