Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 7780 DEA: 112T1824 EFIS: 1100020051
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-805-4.7/5.6
Work Description: REPLACE STRUCTURE AND CONSTRUCT DIRECT ACCESS RAMP (DAR).
Location Description: SAN DIEGO COUNTY IN CHULA VISTA FROM 0.4 MILE SOUTH OF EAST PALOMAR STREET OVERCROSSING TO 0.1 MILE NORTH OF NAPLES STREET UNDERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 5860 El Camino Real #200, Carlsbad, CA 92008
Resident Engineer: Tom Davis Structure Rep.: Anh Ma
DIME Sample ID: 2014-09-04-19
TL Number from the TL Form: Unknown
Sample Submitted By Organization: Vulcan Materials Company - San Diego
Sample Organization Contact: (619) 572-9564
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 09/04/2014
Date that the sample was received by the laboratory/organization performing the testing: 09/04/2014
The quantity of what the sample constitutes: 5 Cylinders
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Source
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: Vulcan Materials
The concrete mix design number: 103612F
The truck number from where the sample was collected: 391
The batch plant ticket number from where the sample was collected: 128493
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: RW 316 Soundwall
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
