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: 2023-04-20-50
TL Number from the TL Form: 166674
Sample Submitted By Organization: CT D02 - Mount Shasta Field Laboratory
Sample Organization Contact: (530) 605-5871
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 04/20/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/20/2023
The quantity of what the sample constitutes: 60 Cubic Yards
A brief description of the sample: Minor Concrete
From where was the sample collected: Job Site
Laboratory sample identification: 001
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mountain Ready Mix
The concrete mix design number: 505S
The truck number from where the sample was collected: 3rd Truck Load
The batch plant ticket number from where the sample was collected: Unknown
Concrete batch plant: Mountain Ready Mix
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Back of truck
Where the material sample would have been placed if not sampled: Sta 240 to 300
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-04-20-50-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: CT D02 - Mount Shasta Field Laboratory
Organization Address: 1625 Mott Road,
Organization City: Mount Shasta
Organization State: CA
Organization Zipcode: 96067
Organization Email: nicole.mallory@dot.ca.gov
Organization Phone: (530) 605-5871
Data has not been verified.
