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Sample Record for 2021-07-15-45

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

Project Information

Project ID: 214114 DEA: 040A5394 EFIS: 0418000244 QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-80,12-11.4/12.8, 2.1/2.8
Work Description: Widen EB SR-12 Connector, Construct 3 ramps & 2 box girder bridges, remove existing bridge, etc.
Location Description: I-80/I-680/Route 12 Interchange
Contractor Name: Kiewit Infrastructure West Co.
Contractor Address: 4650 Business Center Drive, Fairfield, CA 94534
Resident Engineer: Cassaundra Lograsso Structure Rep.: Kambiz Kouchesfahani

Sample Information

DIME Sample ID: 2021-07-15-45
TL Number from the TL Form:
Sample Submitted By Organization: Construction Testing Services
Sample Organization Contact: (925) 351-6905
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 07/15/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/15/2021
The quantity of what the sample constitutes: 1 day of production
A brief description of the sample: Coarse Aggregate
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Cordelia

Material Information

Source Identification (SMARA, name of Pit or Job Site): Cemex Cordelia
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Conveyor Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:

Test Results