Sample Record for 2015-12-29-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 208682 DEA: 083401U4 EFIS: 0800000609
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-138,138-6.2/6.4,2.3/R15.2
Work Description: WIDEN TO 4 LNS FR BEEKLEY RD TO JCT 15, ADD 1 LN EB FR PHELAN RD TO
Location Description: SAN BERNARDINO COUNTY ON ROUTE 138 NEAR PHELAN FROM 0.6 MILE WEST OF PHELAN ROAD TO THE JUNCTION OF ROUTE 15 AND ON ROUTE 2 FROM 0.1 MILE NORTH OF WILD HORSE CANYON ROAD TO ROUTE 138
Contractor Name: Flatiron
Contractor Address: 1770 LA COSTA MEADOWS DRIVE, SAN MARCOS CA 92078
Resident Engineer: Elvira Lenart Structure Rep.: Osama Abdalla
Sample Information
DIME Sample ID: 2015-12-29-2
TL Number from the TL Form: 04
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: 12/29/2015
Date that the sample was received by the laboratory/organization performing the testing: 12/31/2015
The quantity of what the sample constitutes: 6
A brief description of the sample: 6x12
From where was the sample collected: Job Site
Laboratory sample identification: 908-04
Structure unique identifier: DS 25 DECK POUR
Structure name: Unknown
The fabricator/manufacturer/facility name: HI GRDAE
Material Information
The concrete mix design number: S1T172A
The truck number from where the sample was collected: 0186
The batch plant ticket number from where the sample was collected: 724684
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: TRUCK
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
Test Results
