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Sample Record for 2019-10-16-8

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

Project Information

Project ID: 213702 DEA: 041G4304 EFIS: 0412000126 QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-128-R7.4
Work Description: REPLACE BRIDGE, HMA PAVING, DRAINAGE AND RSP
Location Description: NAPA COUNTY NEAR SAINT HELENA AT CONN CREEK
Contractor Name: GHILOTTI CONSTRUCTION CO. INC.
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Paramdeep Brar Structure Rep.: Budu, Nana

Sample Information

DIME Sample ID: 2019-10-16-8
TL Number from the TL Form:
Sample Submitted By Organization: Caltrans Vallejo Field Laboratory
Sample Organization Contact: (510) 774-6009
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 10/16/2019
Date that the sample was received by the laboratory/organization performing the testing: 10/17/2019
The quantity of what the sample constitutes: 2 Cylinders
A brief description of the sample: 6"x12" Cylinders
From where was the sample collected: Fabricator
Laboratory sample identification: 2019-10-16-1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kie-Con Antioch

Material Information

The concrete mix design number: K5060-502a
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: Unknown
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Kie-Con
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.