Sample Record for 2022-05-06-23
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214572 DEA: 034E62U4 EFIS: 0319000068
QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-50-18.5/24.2
Work Description: CONSTRUCT UC, MED BARRIER, DRAINAGE SYSTEMS & HMA OVERLAY.
Location Description: EL DORADO COUNTY IN AND NEAR PLACERVILLE FROM MOSQUITO ROAD UNDERCROSSING TO SCHNELL SCHOOL ROAD UNDERCROSSING AND FROM 0.2 MILE WEST OF STILL MEADOW ROAD TO 0.2 MILE EAST OF CARSON ROAD
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3075 Townsgate Road, Suite 200, Westlake Village, CA 91361
Resident Engineer: Nathan Alterton Structure Rep.: Raymand Macy
Sample Information
DIME Sample ID: 2022-05-06-23
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3665 - Shingle Springs
Sample Organization Contact: (530) 821-8266
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/06/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 6 concrete cylinders
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Syar Concrete Shingle Springs
Material Information
The concrete mix design number: CT072CR5WA
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 41049681
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Back of truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
