Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214680 DEA: 030F2854 EFIS: 0319000205
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99-7.1/9.4
Work Description: Construct the temporary bridge superstructures, adjacent paving and pave temporary alignment
Location Description:
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: Masoud Saed Structure Rep.: Chau Ha
DIME Sample ID: 2020-04-01-13
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California Corporation - Lathrop
Sample Organization Contact: (209) 249-4700
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 04/01/2020
Date that the sample was received by the laboratory/organization performing the testing: 04/02/2020
The quantity of what the sample constitutes: 2
A brief description of the sample: 6"x12" cylinders
From where was the sample collected: Source
Laboratory sample identification: Bed2 4-1-20
Structure unique identifier:
Structure name: Cosumnes River Overflow Temporary Bridge
The fabricator/manufacturer/facility name: Con-Fab California, LLC
The concrete mix design number: VER-85LV
The truck number from where the sample was collected: 2nd
The batch plant ticket number from where the sample was collected: 1433
Concrete batch plant: BP1
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Bed 2, 2ndTruck
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
