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Sample Record for 2017-05-20-1

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

Project Information

Project ID: 212036 DEA: 044K2404 EFIS: 0417000284 QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-1-10.9
Work Description: Construct Solier Pile Wall
Location Description:
Contractor Name: DRILL TECH DRILLING & SHORING
Contractor Address: 2200 WYMORE WAY, ANTIOCH, CA 94509
Resident Engineer: Dawit Habteselassie Structure Rep.: Jeff Kress

Sample Information

DIME Sample ID: 2017-05-20-1
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: 05/20/2017
Date that the sample was received by the laboratory/organization performing the testing: 06/16/2017
The quantity of what the sample constitutes: 2 6x12 concrete cylinders
A brief description of the sample: 6X12 cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Retaining Wall Ground Anchor
The fabricator/manufacturer/facility name: Shamrock Materials

Material Information

The concrete mix design number: 4700P
The truck number from where the sample was collected: 1808
The batch plant ticket number from where the sample was collected: 154359
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Mix Truck Chute
Where the material sample would have been placed if not sampled: soldier pile wall
From Lot No.:
Bag Lot No.:

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.