Sample Record for 2018-05-11-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209695 DEA: 08347704 EFIS: 0800000616
QA Service Level: 1
Work Description: (Alternative Delivery) The CMGC project will upgrade SR 58 from 2- to 4-lanes in San Bernardino County from the Kern County line to 7.5 miles east of US-395.
Location Description: SR-58 / 395 Kramer Junction project. In San Bernardino County from the Kern County line to 7.5 miles east of US-395.
Contractor Name: KIEWIT INFRASTRUCTURE WEST CO.
Contractor Address: 2215 E 1ST STREET, VANCOUVER, WA 98661
Resident Engineer: Shaine Shahidi Structure Rep.: Osama Abdalla
DIME Sample ID: 2018-05-11-6
TL Number from the TL Form: 7
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/11/2018
Date that the sample was received by the laboratory/organization performing the testing: 05/16/2018
The quantity of what the sample constitutes: 2
A brief description of the sample: Concrete Cylinder 6 x 12
From where was the sample collected: Job Site
Laboratory sample identification: 976-7
Structure unique identifier: 54 54 1325L
Structure name: BENT 5L AT BRIDGE NUMBER 54 1325L
The fabricator/manufacturer/facility name: Robertsons LUCERNE
The concrete mix design number: SC675B38
The truck number from where the sample was collected: 1195
The batch plant ticket number from where the sample was collected: 3331307
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Batch plant
A detailed description of where the material sample was collected: middleof the load
Where the material sample would have been placed if not sampled: BENT 5L AT BRIDGE NUMBER 54 1325L
From Lot No.: Unknown
Bag Lot No.: Unknown