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Sample Record for 2021-10-14-9

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

Project Information

Project ID: 993292 DEA: 041W7501 EFIS: 0421000091 QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-121-
Work Description:
Location Description:
Contractor Name: Rage Construction Inc
Contractor Address: 600 Santana Drive, Cloverdale CA 95425
Resident Engineer: Sardar Chalabe Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-10-14-9
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: Per Request
Type of Material: Water
Sample Taken Date: 10/14/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/15/2021
The quantity of what the sample constitutes: 1 bottle apprx 200ml
A brief description of the sample: water sample from the inlet of the culvert
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Field

Material Information

Sample is potable water: No
A detailed description of where the material sample was collected: PM 4.16 , 38.2118 E, -122.5214N

Test Results