Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 77777 DEA: CHEM-STOCK EFIS: CHEM-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for Chem Lab stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2021-07-16-6
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 07/16/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/16/2021
The quantity of what the sample constitutes: 6
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: OLDCASTLE PRECAST
The concrete mix design number: 4573
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 46457687
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: from mix truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2021-07-16-6-1
Test Method: CTM TEMP1-16: Test Method for Monitoring Precast Concrete Curing Temperature (Curing temperature)
Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Organization Address: 13230 East Firestone Boulevard,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: adriana.ortiz@dot.ca.gov
Organization Phone: (323) 805-3068
Data has not been verified.
