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Sample Record for 2015-02-27-3

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

Project Information

Project ID: 209135 DEA: 04235844 EFIS: 0400000684 COOP: 042493 QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101-16.3/17.06
Location Description: BURLINGAME
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Douglas Inori Structure Rep.: Jordan Jarosz

Sample Information

DIME Sample ID: 2015-02-27-3
TL Number from the TL Form: 192454
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Informational
Type of Material: Concrete
Sample Taken Date: 02/27/2015
Date that the sample was received by the laboratory/organization performing the testing: 03/02/2015
The quantity of what the sample constitutes: 2
A brief description of the sample: 6x12 cylinders
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Wide Flange Girder
The fabricator/manufacturer/facility name: Kiecon

Material Information

The concrete mix design number: K6080605
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: 64340
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Kiecon
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
2015-02-27-3-1ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens03/02/201503/13/2015William SommerCT HQ - QASI Bay Area Field Officec1231