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Sample Record for 2021-09-24-2

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

Project Information

DEA: No Project QA Service Level:
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-09-24-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/24/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 9 QA cylinders
A brief description of the sample: Mass Pour Conc. at 2300
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Pier 20
The fabricator/manufacturer/facility name: Feather River Bridge

Material Information

The concrete mix design number: 9999999999
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 777
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Truck 8
Where the material sample would have been placed if not sampled: Mass Concrete Cap
From Lot No.:
Bag Lot No.:

Test Results