Sample Record for 2019-08-16-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 210617 DEA: 042J1004 EFIS: 0414000426 COOP: 042549
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-29-11.3/11.6
Work Description: CONSTRUCT TWO SEPARATE ROUNDABOUT PROJECTS TOGETHER INTO ONE SINGLE PROJECT AND CONSTRUCTION CONTRACT.
Location Description: AT THE INTERSECTIONS OF FIRST STREET/ CALIFORNIA BLVD AND SECOND STREET/CALIFORNIA BLVD (CITY) AND AT HE STATE ROUTE 29 NORTHBOUND ON AND OFF RAMPS AND FIRST STREET ( CALTRANS)
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: 1520 4th Street, Berkeley, CA 94710
Resident Engineer: Danilo Patenia Structure Rep.: Mohammad Nasim
Sample Information
DIME Sample ID: 2019-08-16-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 08/16/2019
Date that the sample was received by the laboratory/organization performing the testing: 08/19/2019
The quantity of what the sample constitutes: 2 6x12 concrete cylinders
A brief description of the sample: Retaining Wall #1 Stem
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Shamrock Materials
Material Information
The concrete mix design number: 4201A
The truck number from where the sample was collected: 2
The batch plant ticket number from where the sample was collected: 729976
Concrete batch plant: Shamrock Materials
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: truck chute
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
Test Results
