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

Sample Record for 2020-05-26-7


Project Information

Project ID: 214190 DEA: 024G41U4 EFIS: 0218000047 QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS,SIS-5-Var
Work Description: REPLACE REINFORCED CONCRETE BRIDGES & CONSTRUCT RETAINING WALL.
Location Description: SHASTA AND SISKIYOU COUNTIES ABOUT 7 MILES NORTH OF POLLARD FLAT FROM 0.8 MILE SOUTH TO 0.7 MILE NORTH OF SIMS ROAD UNDERCROSSING AND FROM 0.6 MILE SOUTH OF CASTLE CRAGS DRIVE UNDERCROSSING TO 0.2 MILE SOUTH OF SOUTH DUNSMUIR UNDERCROSSING
Contractor Name: J.F. Shea Construction, Inc. Contractor Address: 17400 Clear Creek Road
Resident Engineer: Nicole Mallory Structure Rep.: Scardaci, Adam

Sample Information

DIME Sample ID: 2020-05-26-7
TL Number from the TL Form:
Sample Submitted By Organization: Caltrans Vallejo Field Laboratory
Sample Organization Contact: (510) 774-6009
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/26/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/27/2020
The quantity of what the sample constitutes: 2 - 6x12 cylinders
A brief description of the sample: 6" x 12" cylinders
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

The concrete mix design number: K6065-604
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: 0
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Kie-Con Antioch
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown