Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2017-08-11-7
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Oakland (YBITS2) Field Laboratory
Sample Organization Contact: (510) 286-4247
Type of Sample: Verification
Type of Material: Concrete Core
Sample Taken Date: 08/11/2017
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 3 cores
A brief description of the sample: Bridge deck location abc
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Fab-man-fac
Detail description: Sampling bridge cores and dropping them off to concrete lab to test Preparing dime info from a cell phone
Structure names: ABC bridged the
Type of material: Concrete core
