Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214698 DEA: 120N8904 EFIS: 1214000130
QA Service Level: 1
DIST-CO-RTE-PM: 12---
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2019-07-22-32
TL Number from the TL Form: C-17303-2
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Preliminary
Type of Material: Soil
Sample Taken Date: 07/22/2019
Date that the sample was received by the laboratory/organization performing the testing: 11/15/2019
The quantity of what the sample constitutes: 1 ZIPLOCK BAG
A brief description of the sample: NATIVE SOIL 15' DEPTH
From where was the sample collected: Job Site
Laboratory sample identification: 8874
Structure unique identifier:
Structure name: RTE 133 PM 8 5 PM 9 3
The fabricator/manufacturer/facility name: NATIVE
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: RTE 133 PM 8.5 -9.3 A-19-005 S-3 15 DEPTH
Where the material sample would have been placed if not sampled: Unknown
DIME Test ID: 2019-07-22-32-1
Test Method: CTM 204-June 2010: Method of Test for Liquid Limit, Plastic Limit and Plasticity Index of Soils (Plasticity Index)
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
Data has not been verified.
