Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 99999 DEA: 0322222
QA Service Level:
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Michael Maksimovich Structure Rep.: Unknown
DIME Sample ID: 2014-07-02-22004051
TL Number from the TL Form:
Sample Submitted By Organization: ZZCT - Sacramento DIME Development - AVS Testing Internal
Sample Organization Contact:
Type of Sample: Verification
Type of Material: Concrete
Sample Taken Date: 07/02/2014
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Type II Cement
From where was the sample collected: Source
Laboratory sample identification: P7-009
Structure unique identifier: p7-009
Structure name:
The fabricator/manufacturer/facility name: Associate Ready Mix - LA
The concrete mix design number: 559336
The truck number from where the sample was collected: N/A
The batch plant ticket number from where the sample was collected: 4817119
Concrete batch plant: 201H215051
The fabricator/manufacturer designation for the sample: lehigh
A detailed description of where the material sample was collected: under the hopper as per CTM 125
Where the material sample would have been placed if not sampled: to the production system
From Lot No.:
Bag Lot No.:
