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Sample Record for 2019-11-25-25

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

Project Information

Project ID: 213977 DEA: 081J1404 EFIS: 0817000214 QA Service Level: 1
DIST-CO-RTE-PM: 08--,40&58-
Work Description:
Location Description:
Contractor Name: RV CONCRETE INC
Contractor Address: 605 E. COMMERCIAL ST., ANAHEIM CA 92801
Resident Engineer: Khoa Nguyen Structure Rep.: Leonard Romero

Sample Information

DIME Sample ID: 2019-11-25-25
TL Number from the TL Form: Sacramento Caltrans lab
Sample Submitted By Organization: Kwik Bond Polymers
Sample Organization Contact: 760-518-6064
Type of Sample: Quality Control
Type of Material: Polyester
Sample Taken Date: 11/25/2019
Date that the sample was received by the laboratory/organization performing the testing: 11/25/2019
The quantity of what the sample constitutes: 2 tankers
A brief description of the sample: 1 gallon can
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers and Reichhold

Material Information

Mfg. Lot Number(s): 1217370
Batch number: 1217370
Mix number: 1217370

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.