Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213466 DEA: 034H4404
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-80-50.78
Work Description: Replace 72" CMP culvert and invert pave the length of the culvert
Location Description:
Contractor Name: LORANG BROTHERS CONSTRUCTION, INC.
Contractor Address: 1175 SOUTH AUBURN STREET, COLFAX, CA 95713
Resident Engineer: PHIL ZINK Structure Rep.: Unknown
DIME Sample ID: 2023-06-28-30
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Chico Field Laboratory
Sample Organization Contact: (916) 799-4305
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 06/28/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/30/2023
The quantity of what the sample constitutes: 3 4x8 concrete cylinders
A brief description of the sample: Textured Wall Pile 154-144
From where was the sample collected: Job Site
Laboratory sample identification: 23-118
Structure unique identifier:
Structure name: Solder Pile retaining Wall
The fabricator/manufacturer/facility name: Shasta Ready Mix
The concrete mix design number: CT-67SSLA50
The truck number from where the sample was collected: 41
The batch plant ticket number from where the sample was collected: 77946
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Textured Wall pile 154- plie 144
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
