Sample Record for 2015-04-10-9
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
Work Description: RECONSTRUCT OVERCROSSING, RETAINING WALLS, GROUND IMPROVEMENT,
Location Description: BURLINGAME
Contractor Name: GHILOTTI CONSTRUCTION COMPANY
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Douglas Inori Structure Rep.: Jordan Jarosz
Sample Information
DIME Sample ID: 2015-04-10-9
TL Number from the TL Form: 193601
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: 04/10/2015
Date that the sample was received by the laboratory/organization performing the testing: 04/13/2015
The quantity of what the sample constitutes: 2
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: 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: 0
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: fabricator
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
Test 1 of 1
DIME Test ID: 2015-04-10-9-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C617/CTM521
Submitted By Organization: CT HQ - QASI Bay Area Field Office
Organization Address: 690 Walnut Avenue, Suite 150,
Organization City: Vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: maged.g.armanuse@dot.ca.gov
Organization Phone: (916) 284-6784
Data has not been verified.
