Sample Record for 2023-08-10-47
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993715 DEA: 010G1404 EFIS: 0116000129
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-96,169-VAR
Work Description: HUM 96-169 5 Bridges Rail Upgrade (Do not include in project name: STRUCTURAL STEEL, CONCRETE BARRIER, POLYESTER CONCRETE OVERLAY)
Location Description: HUMBOLDT COUNTY ON ROUTES 96 AND 169 AT VARIOUS LOCATIONS (Bridge Nos. 04-0215, 04-0059, 04-0063, 04-0225, 04-0061)
Contractor Name: Steelhead Constructors JV
Contractor Address: P.O. Box 536, Palo Cedro, CA 96073
Resident Engineer: Efren Banuelos Structure Rep.: Laura Cangas
Sample Information
DIME Sample ID: 2023-08-10-47
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 08/10/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/11/2023
The quantity of what the sample constitutes: 3 4x8 cylinders
A brief description of the sample: TYPE II/V CEMENT
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 12-04-0059
Structure name: Aikens Creek Bridge
The fabricator/manufacturer/facility name: Mercer Fraser Company, Willow Creek Plant
Material Information
The concrete mix design number: MFCL1-45SLAGWC
The truck number from where the sample was collected: 694
The batch plant ticket number from where the sample was collected: WC01482
Concrete batch plant: Willow Creek Mercer Fraser Plant
The fabricator/manufacturer designation for the sample: Batch
A detailed description of where the material sample was collected: CHUTE FROM TRUCK
Where the material sample would have been placed if not sampled: approach slab
From Lot No.:
Bag Lot No.:
Test Results
