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Sample Record for 2018-01-17-5

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

Project Information

Project ID: 212351 DEA: 040P1304 EFIS: 0417000402 QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-1-11.5
Work Description: Construct Soldier Pile Wall with Tiebacks
Location Description: Route 1 PM 11.5
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Gina Choi Structure Rep.: Sarah Rusby

Sample Information

DIME Sample ID: 2018-01-17-5
TL Number from the TL Form:
Sample Submitted By Organization: CT SC Sub-unit 3676-106
Sample Organization Contact:
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 01/17/2018
Date that the sample was received by the laboratory/organization performing the testing: 01/04/2018
The quantity of what the sample constitutes: 36 CY
A brief description of the sample: 6 X 12 Concrete Cylinder
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: Upper Waler
Structure name: Retaining Wall 1
The fabricator/manufacturer/facility name: Shamrock Materials

Material Information

The concrete mix design number: 3172GG
The truck number from where the sample was collected: 1951
The batch plant ticket number from where the sample was collected: 458838
Concrete batch plant: Shamrock San Rafael
The fabricator/manufacturer designation for the sample: Shamrock Materials
A detailed description of where the material sample was collected: Back of Truck
Where the material sample would have been placed if not sampled: Concrete Waler
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.