Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210862 DEA: 031F4004 EFIS: 0300020420
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-80-35.1/38.3
Work Description: WIDEN EASTBOUND ROADWAY
Location Description: WIDEN EASTBOUND ROADWAY
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 400 Sunrise Ave. Ste. 300, Roseville, CA 95661
Resident Engineer: Phil Zink Structure Rep.: Carl Anderson
DIME Sample ID: 2016-07-08-23
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: 07/08/2016
Date that the sample was received by the laboratory/organization performing the testing: 07/11/2016
The quantity of what the sample constitutes: 2
A brief description of the sample: Concrete Cyliders
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: kiecon
The concrete mix design number: ct60-v21
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
DIME Test ID: 2016-07-08-23-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C617/CTM521
Submitted By Organization: CT HQ - QASI Bay Area Field Office
Organization Address: 690 Walnut Avenue, Suite 150,
Organization City: Vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: maged.g.armanuse@dot.ca.gov
Organization Phone: (916) 284-6784
Data has not been verified.
