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Sample Record for 2022-03-11-14

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

Project Information

Project ID: 214336 DEA: 07302404 EFIS: 0713000488 QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-101-37/40
Work Description: PADRE JUAN REHAB
Location Description: VEN 101
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 4820 McGrath Street, Suite 101, Ventura, CA 93003
Resident Engineer: Alfred Ira Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2022-03-11-14
TL Number from the TL Form:
Sample Submitted By Organization: Kleinfelder, Incorporated - Los Angeles
Sample Organization Contact: (909) 833-5780
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 03/11/2022
Date that the sample was received by the laboratory/organization performing the testing: 03/12/2002
The quantity of what the sample constitutes: 8 CY
A brief description of the sample: A set of 3 ISR-RSC Beams
From where was the sample collected: Job Site
Laboratory sample identification: 22-0461
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Short Load Concrete Inc

Material Information

The concrete mix design number: CTS-65-EHI
The truck number from where the sample was collected: Load 1
The batch plant ticket number from where the sample was collected: NOT PROVIDED
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results