Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 99999 DEA: 0322222
QA Service Level:
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Michael Maksimovich Structure Rep.: Unknown
DIME Sample ID: 2022-11-17-6
TL Number from the TL Form: 1295361
Sample Submitted By Organization: CT D06 - Bakersfield Field Laboratory
Sample Organization Contact: 661-549-8281
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 11/17/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/17/2022
The quantity of what the sample constitutes: Three 4x8 cylinders
A brief description of the sample: Concrete
From where was the sample collected: Job Site
Laboratory sample identification: 10213A
Structure unique identifier:
Structure name: Rehabilitate Pavement
The fabricator/manufacturer/facility name: Security Paving batch plant
The concrete mix design number: CT675F2
The truck number from where the sample was collected: 8
The batch plant ticket number from where the sample was collected: 6947
Concrete batch plant: Security Paving Company
The fabricator/manufacturer designation for the sample: SECURITY PAVING
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled: pavement
From Lot No.: 1
Bag Lot No.: 1
