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Sample Record for 2015-07-07-2

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

Project Information

Project ID: 208862 DEA: 080K7104 EFIS: 0800000366 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15,215-14.0/R16.4,16.0/17.8
Work Description: I-15/I-215 Interchange Improvements (Devore)
Location Description: On I-15 from 0.8 mile south of Glen Helen Parkway UC to 1.4 mile north of Kenwood Ave UC And On I-215 from 1.2 mile south of Devore Road OC to the I-15 junction
Contractor Name: Atkinson Construction,, LLC
Contractor Address: 1672 Devore Road, San Bernardino, CA 92407
Resident Engineer: Owen Spencer Structure Rep.: Scott Gueltzow

Sample Information

DIME Sample ID: 2015-07-07-2
TL Number from the TL Form: 150709B
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 07/07/2015
Date that the sample was received by the laboratory/organization performing the testing: 07/07/2015
The quantity of what the sample constitutes: 4
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 868-09B
Structure unique identifier: Unknown
Structure name: Bridge 22 Deck
The fabricator/manufacturer/facility name: Holliday

Material Information

The concrete mix design number: CT1-4500DI
The truck number from where the sample was collected: 7
The batch plant ticket number from where the sample was collected: Not provided
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Plant
A detailed description of where the material sample was collected: Chute
Where the material sample would have been placed if not sampled: Bridge 22 Deck Pour 1
From Lot No.:
Bag Lot No.:

Test Results