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Sample Record for 2021-01-09-4

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

Project Information

Project ID: 213746 DEA: 080Q75U4 EFIS: 0817000114 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD,RIV-60-R4.6/R9.9, R0.0/12.2
Location Description:
Contractor Name: J McLoughlin Engineering
Contractor Address: 10641 Fulton Court, Rancho Cucamonga, CA 91730
Resident Engineer: Mujahid Qureshi Structure Rep.: Ching Chuang

Sample Information

DIME Sample ID: 2021-01-09-4
TL Number from the TL Form: 999-109B
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 01/09/2021
Date that the sample was received by the laboratory/organization performing the testing: 01/20/2021
The quantity of what the sample constitutes: CONCRETE CYLINDERS
A brief description of the sample: CONCRETE CYLINDERS
From where was the sample collected: Job Site
Laboratory sample identification: 999-109B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Short Load Concrete Inc

Material Information

The concrete mix design number: CTS-30-RAM
The truck number from where the sample was collected: NA
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant: VOLUMETRIC TRUCK
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: SITE
Where the material sample would have been placed if not sampled: NA
From Lot No.:
Bag Lot No.:

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
2021-01-09-4-1ASTM C39-17a: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens01/20/2021Not scheduledMatthew ClaytonCT D08 - Fontana Southern Regional Laboratory