Sample Record for 2024-01-17-13
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214590 DEA: 043G4744 EFIS: 0412000074
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN,MRN-580-6.9/7.8,0.0/2.5
Work Description: CLEAN AND PAINT STRUCTURAL STEEL BRIDGE.
Location Description: CONTRA COSTA AND MARIN COUNTIES IN RICHMOND AND SAN RAFAEL FROM 0.8 MILE WEST OF TOLL PLAZA TO 0.1 MILE EAST OF MAIN STREET
Contractor Name: Allied Painting, INC.
Contractor Address: 4 Larwin Road, Cherry Hill, NJ08034
Resident Engineer: Behzad Halali Structure Rep.: William Sommer
Sample Information
DIME Sample ID: 2024-01-17-13
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3672 - Richmond
Sample Organization Contact: (510) 231-7108
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 01/17/2024
Date that the sample was received by the laboratory/organization performing the testing: 01/18/2024
The quantity of what the sample constitutes: 5 lb
A brief description of the sample: 1/2" Hallwood Coarse
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 28-0100
Structure name: Richmond San Rafael Bridge
The fabricator/manufacturer/facility name: Teichert Materials Hallwood
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-58-0006
The fabricator's/manufacturer's product name for the sample: Hallwood 1/2”
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Contractors yard stockpile
Where the material sample would have been placed if not sampled: Joint header concrete
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 21005-12
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
