*Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Sample Record for 2019-09-01-1


Project Information

Project ID: 9999 DEA: 00000000 EFIS: 0000000000 COOP: 99999333399 MINOR: 333333 Permit Numbers: 555555 0400NRT0000 QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: YYZ Contractor Address: 1234 address
Resident Engineer: RE_first RE_last Structure Rep.: SR_Last, SR_First

Sample Information

DIME Sample ID: 2019-09-01-1
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Office of Structural Materials Field Laboratory
Sample Organization Contact: 7146885366
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 09/01/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1
A brief description of the sample: 4
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

Source Identification (SMARA or name of Pit): 1212
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: 12
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number: