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Sample Record for 2017-04-27-11


Project Information

Project ID: 210871 DEA: 044G4604 EFIS: 0412000480 QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-1.5/14.0
Work Description: REMOVE EXISTING AND CONSTRUCT NEW BRIDGE RAILINGS.
Location Description: IN MARIN COUNTY, AT VARIOUS LOCATION, FROM SPENCER AVE OVERCROSSING TO NORTH BRANCHGALLINAS CREEK BRIDGE
Contractor Name: GHILOTTI BROS / RM HARRIS JV Contractor Address: 525 JACOBY STREET
Resident Engineer: Hal Streater Structure Rep.: Li, Long

Sample Information

DIME Sample ID: 2017-04-27-11
TL Number from the TL Form:
Sample Submitted By Organization: CT SC Sub-unit 3672-104
Sample Organization Contact:
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/27/2017
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2 6x12 concrete cylinders
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Corte Madera Creek Bridge SB

Material Information

The concrete mix design number: 4700B
The truck number from where the sample was collected: 1208
The batch plant ticket number from where the sample was collected: 153925
Concrete batch plant: 1
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: truck chute
Where the material sample would have been placed if not sampled: Overhang Corbel
From Lot No.:
Bag Lot No.: