Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 10016 DEA: 06342524 EFIS: 0600000381
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-180-R71.8/74.5
Work Description: NEW EXPRESS HIGHWAY
Location Description: FRESNO COUNTY ABOUT 6.3 MILES EAST OF FRESNO FROM 0.6 MILE WEST OF QUALITY AVENUE TO 0.2 MILE WEST OF SMITH AVENUE
Contractor Name: American Paving Co
Contractor Address: 315 North Thorne Avenue, Fresno, CA 93706
Resident Engineer: Mark Mengoni Structure Rep.: Mike Bloom
DIME Sample ID: 2013-10-22-10155961
TL Number from the TL Form:
Sample Submitted By Organization: Trinity Engineering Laboratories, Incorporated - Fresno
Sample Organization Contact: (559) 292-2188
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 10/22/2013
Date that the sample was received by the laboratory/organization performing the testing: 10/22/2013
The quantity of what the sample constitutes: 8 concrete cylinders
A brief description of the sample: Type II Cement
From where was the sample collected: Source
Laboratory sample identification: 2013-10-22-1015-2
Structure unique identifier: abuttment 7
Structure name: lone tree canal
The fabricator/manufacturer/facility name: Builders Concrete Ready Mix Plant Sanger
The concrete mix design number: ND22123
The truck number from where the sample was collected: 9462
The batch plant ticket number from where the sample was collected: 101158
Concrete batch plant: 111
The fabricator/manufacturer designation for the sample: Plant
A detailed description of where the material sample was collected: abuttment 7
Where the material sample would have been placed if not sampled: abuttment 7
From Lot No.:
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