Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211162 DEA: 044G4504 EFIS: 0412000477
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-780-7.07
Work Description: REPLACE BRIDGE TO PROVIDE STANDARD VERTICAL CLEARANCE
Location Description: LAUREL STREET OC
Contractor Name: R N R CONSTRUCTION, INC.
Contractor Address: 8589 Thys Court, Sacramento, CA 95828
Resident Engineer: Jolie Schneider Structure Rep.: Joe De La Torre
DIME Sample ID: 2017-10-20-9
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Informational
Type of Material: Concrete
Sample Taken Date: 10/20/2017
Date that the sample was received by the laboratory/organization performing the testing: 10/20/2017
The quantity of what the sample constitutes: 2
A brief description of the sample: RSC Bridge Deck 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: Precision Concrete
The concrete mix design number: 7337 Rapid Set TH
The truck number from where the sample was collected: UNK
The batch plant ticket number from where the sample was collected: UNK
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Volumetric Mixer
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
