Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213267 DEA: 04013584 EFIS: 0416000289
QA Service Level: 1
DIST-CO-RTE-PM: 04-SF-80-8.0/8.3,0.9/1.4
Work Description: Pier Retention
Location Description: In San Francisco and Alameda Counties on Yerba Buena Island and .4 miles west of Oakland Toll plaza
Contractor Name: Kiewit/Manson, AJV
Contractor Address: 4650 Business Center Drive, Fairfield,CA 94804
Resident Engineer: Brian Boal Structure Rep.: Unknown
DIME Sample ID: 2018-09-11-16
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT SC - 3676 - 104
Sample Organization Contact:
Type of Sample: Verification
Type of Material: Concrete
Sample Taken Date: 09/11/2018
Date that the sample was received by the laboratory/organization performing the testing: 09/11/2018
The quantity of what the sample constitutes: 6 CY
A brief description of the sample: 6 X 12 Concrete Cylinder
From where was the sample collected: Job Site
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: Central
The concrete mix design number: 4E01C5SS
The truck number from where the sample was collected: 8162
The batch plant ticket number from where the sample was collected: 18704555
Concrete batch plant: 30
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Concrete Truck
Where the material sample would have been placed if not sampled: Mock Slab
From Lot No.: Unknown
Bag Lot No.: Unknown
