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Sample Record for 2017-08-21-18

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

Project Information

Project ID: 211778 DEA: 04235654 EFIS: 0400000680 QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101,114-1.3/2.5,5.0/5.3
Work Description: RECONSTRUCT INTERCHANGE
Location Description: SAN MATEO COUNTY AT VARIOUS LOCATIONS ON ROUTE 101 FROM 0.4 MILE NORTH OF UNIVERSITY AVENUE OVERCROSSING TO 0.6 MILE SOUTH OF HENDERSON UNDERPASS AND ON ROUTE 114 FROM WILLOW ROAD SEPARATION TO NEWBRIDGE STREET
Contractor Name: Disney/OC Jones Construction Company Inc.
Contractor Address: 533 Airport Blvd, Suite 120, Burlingame, CA 94010
Resident Engineer: Fernando Abela Structure Rep.: Bui, Oanh

Sample Information

DIME Sample ID: 2017-08-21-18
TL Number from the TL Form: Unknown
Sample Submitted By Organization: Caltrans Vallejo Field Laboratory
Sample Organization Contact: (510) 774-6009
Type of Sample: Informational
Type of Material: Concrete
Sample Taken Date: 08/21/2017
Date that the sample was received by the laboratory/organization performing the testing: 08/29/2017
The quantity of what the sample constitutes: 2
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: kiecon

Material Information

The concrete mix design number: ct60vt2
The truck number from where the sample was collected: Unknown
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: fabricator
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown

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.