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: 2023-04-04-28
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Per Request
Type of Material: SMTL TM6 - Steel Check Sample Plate
Sample Taken Date: 04/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/05/2023
The quantity of what the sample constitutes: 2
A brief description of the sample: One round 3.75" diameter; one rectangular 8" x 4"
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Overhead Sign Structure Rte 113 Davis
The fabricator/manufacturer/facility name: Unknown
