Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 7285 DEA: 040120T4 EFIS: 0400000027
QA Service Level: 1
DIST-CO-RTE-PM: 04-SF-80-12.6/13.9
Work Description: CONSTRUCT BRIDGE, ROADWAYS, ELECTRICAL, BUILDINGS AND REMOVE BRIDGES
Location Description: THE CITY AND COUNTY OF SAN FRANCISCO FROM THE YERBA BUENA TUNNEL TO 1.3 KM EAST OF THE YERBA BUENA TUNNEL
Contractor Name: CALIFORNIA ENGINEERING CONTRACTORS, INC.
Contractor Address: 20 HAPPY VALLEY ROAD, PLEASANTON, CA 94566
Resident Engineer: Tom Larwin Structure Rep.: Mehran Ardakanian
DIME Sample ID: 2016-01-11-1
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT D04 - Oakland (YBITS II) 171 Burma Road Field Laboratory
Sample Organization Contact: (510) 286-0510
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 01/11/2016
Date that the sample was received by the laboratory/organization performing the testing: 01/11/2016
The quantity of what the sample constitutes: 2 cylinders
A brief description of the sample: Concrete Cylinder 6 x 12
From where was the sample collected: Job Site
Laboratory sample identification: Unknown
Structure unique identifier: 350006S
Structure name: YBI EB Ramp
The fabricator/manufacturer/facility name: Central Concrete
The concrete mix design number: D101C5E1
The truck number from where the sample was collected: 1245
The batch plant ticket number from where the sample was collected: 18152362
Concrete batch plant: 12
The fabricator/manufacturer designation for the sample: 1092
A detailed description of where the material sample was collected: Discharged from the Concrete Truck
Where the material sample would have been placed if not sampled: Barrier
From Lot No.: Unknown
Bag Lot No.: Unknown
