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

Sample Record for 2013-10-23-6084114


Project Information

Project ID: 7780 DEA: 112T1824 EFIS: 1100020051 QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-805-4.7/5.6
Work Description: REPLACE STRUCTURE AND CONSTRUCT DIRECT ACCESS RAMP (DAR).
Location Description: SAN DIEGO COUNTY IN CHULA VISTA FROM 0.4 MILE SOUTH OF EAST PALOMAR STREET OVERCROSSING TO 0.1 MILE NORTH OF NAPLES STREET UNDERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY Contractor Address: 5860 El Camino Real #200
Resident Engineer: Tom Davis Structure Rep.: Ma, Anh

Sample Information

DIME Sample ID: 2013-10-23-6084114
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: Verification
Type of Material: Concrete
Sample Taken Date: 10/23/2013
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2 cylinders
A brief description of the sample: PCC
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

The concrete mix design number: 12345
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 12345677
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.: