Sample Record for 2022-12-02-21
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993279 DEA: 010E0904 EFIS: 0113000123
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-20-33.3/34.4
Work Description: CONSTRUCT NEW BRIDGE, REMOVE TWO BRIDGES, EARTHWORK AND PAVING. (Bridge No. 10-0310)
Location Description: MENDOCINO COUNTY NEAR UKIAH FROM 0.3 MILE WEST OF RUSSIAN RIVER BRIDGE AND OVERHEAD TO 0.3 MILE EAST OF COUNTY ROAD 144
Contractor Name: Myers & Sons Construction LLC
Contractor Address: 4600 Northgate Blvd, Suite 100, Sacramento, CA 95838
Resident Engineer: Geoffrey Wright Structure Rep.: Kari Forbes
Sample Information
DIME Sample ID: 2022-12-02-21
TL Number from the TL Form:
Sample Submitted By Organization: Myers and Sons Construction
Sample Organization Contact: (650) 864-2057
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 12/02/2022
Date that the sample was received by the laboratory/organization performing the testing: 12/02/2022
The quantity of what the sample constitutes: (4) 4x8 cylinders
A brief description of the sample: Bent 2 Column
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 10-0310
Structure name:
The fabricator/manufacturer/facility name: NorCal
Material Information
The concrete mix design number: 850342
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 43087
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete Truck Chute
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
