Sample Record for 2018-08-13-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212408 DEA: 09350804 EFIS: 0900020055
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-395-80.6/84.1
Work Description: CONSTRUCT PULVERIZED ROADBED, HMA AND ANCHORED WIRE MESH SYSTEM.
Location Description: MONO COUNTY NEAR BRIDGEPORT FROM BUCKEYE ROAD TO 2.9 MILES SOUTH OF SWAUGER CANYON ROAD
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: PO BOX 2210, PISMO BEACH PO BOX 2210 CA 9344
Resident Engineer: Lee Scotese Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2018-08-13-3
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 08/13/2018
Date that the sample was received by the laboratory/organization performing the testing: 08/14/2018
The quantity of what the sample constitutes: 1 set of 2
A brief description of the sample: RW1 Wall Pour
From where was the sample collected: Job Site
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: RW1 Wall
The fabricator/manufacturer/facility name: Mammoth ready mix
Material Information
The concrete mix design number: 1304-18-25
The truck number from where the sample was collected: 141
The batch plant ticket number from where the sample was collected: 43187
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: RW1 Wall pour at Sta 111 plus 55
Where the material sample would have been placed if not sampled: RW1 Wall at Sta 111 plus 55
From Lot No.: Unknown
Bag Lot No.: Unknown
Test Results
