Sample Record for 2020-02-06-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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, Sacramento, CA 95824
Resident Engineer: RE_first RE_last Structure Rep.: SR_First SR_Last
Sample Information
DIME Sample ID: 2020-02-06-1
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QAM Sacramento Field Laboratory
Sample Organization Contact: (916) 227-7266
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 02/06/2020
Date that the sample was received by the laboratory/organization performing the testing: 02/06/2020
The quantity of what the sample constitutes: 250 cy
A brief description of the sample: coarse aggregate
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Matls Vernalis
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-37-0037::BORDER HIGHLANDS PIT
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Stockpile @ Plant
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:
Test Results
