Sample Record for 2015-08-28-5
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 210749 DEA: 081G5114
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-57.6/127.0, R57.6-R127.0, R57.6/R127
Work Description: Secure bridges and build a crossover at Tex Wash
Location Description: In Riverside County from Jct 86/10 to Arco Ditch
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 38000 Monroe St, Indio, CA 92203
Resident Engineer: Andy Quach Structure Rep.: Shukri Abouazra
Sample Information
DIME Sample ID: 2015-08-28-5
TL Number from the TL Form: L79 0CPP 004
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/28/2015
Date that the sample was received by the laboratory/organization performing the testing: 09/01/2015
The quantity of what the sample constitutes: 2
A brief description of the sample: 6x12
From where was the sample collected: Job Site
Laboratory sample identification: 920-04
Structure unique identifier: TEX WASH RIGHT BRIDGE
Structure name: Unknown
The fabricator/manufacturer/facility name: OLDCASTLE PRECAST
Material Information
The concrete mix design number: UV 273 85SAC
The truck number from where the sample was collected: NA
The batch plant ticket number from where the sample was collected: XXXXXXX
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: TUCKER DISCHARGE
Where the material sample would have been placed if not sampled: Unknown
From Lot No.:
Bag Lot No.:
Test Results
