Sample Record for 2014-07-28-9006112
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 6919 DEA: 032A9204 EFIS: 0300000297
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA,PLA-89-27.2/27.4,0.0/T8.5
Work Description: REHAB PAVEMENT AND DRAINAGE SYSTEM.
Location Description: EL DORADO AND PLACER COUNTIES AT AND NEAR TAHOE CITY FROM 0.2 MILE SOUTH OF THE EL DORADO/PLACER COUNTY LINE TO THE TRUCKEE RIVER BRIDGE
Contractor Name: ROAD AND HIGHWAY BUILDERS OF CALIFORNIA, INC.
Contractor Address: P.O. Box 70846, Reno, NV 89570
Resident Engineer: Roy Iskin Structure Rep.: Jimmer Ross
Sample Information
DIME Sample ID: 2014-07-28-9006112
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Informational
Type of Material: Concrete
Sample Taken Date: 07/28/2014
Date that the sample was received by the laboratory/organization performing the testing: 08/01/2014
The quantity of what the sample constitutes: 2
A brief description of the sample: Sand Vault 41P
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Oldcastle Truckee
Material Information
The concrete mix design number: 12
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 194331
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: By formwork at precast plant during pour inspection
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
