Sample Record for 2015-02-03-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 209059 DEA: 033E1004 EFIS: 0300000473
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-80-8.1/37.8
Work Description: IMPROVING VERTICAL CLEARANCE
Location Description: PLACER COUNTY IN AND NEAR LOOMIS, PENRYN, NEWCASTLE, WEIMAR, AND MAGRA FROM 0.1 MILE WEST OF BRACE ROAD OVERCROSSING TO 0.1 MILE EAST OF MAGRA OVERCROSSING
Contractor Name: RGW Construction Inc
Contractor Address: 550 Greenville Road, Livermore, Ca 94550
Resident Engineer: Martin Clark Structure Rep.: Glen Wheeler
Sample Information
DIME Sample ID: 2015-02-03-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Sacramento Sanders Structures Construction Field Office
Sample Organization Contact: (916) 505-6839
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 02/03/2015
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2 6x12 concrete cylinders
A brief description of the sample: 2 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert
Material Information
The concrete mix design number: J7A8543CC
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 2
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
