Sample Record for 2024-04-04-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212302 DEA: 080C70U4 EFIS: 0815000189 COOP: 081646
QA Service Level: 2
DIST-CO-RTE-PM: 08-SBD-210-PM R 25
Work Description: The SR 210 Base Line Interchange project, in the City of Highland, includes widening of the Base Line overcrossing at the SR 210, along with additional ramp widening improvements for the northbound on-ramp, northbound off-ramp and southbound on-ramps.
Location Description: SR210 Lane Addition work proposes to improve SR 210 within the cities of Highland, Redlands, San Bernardino and unincorporated sections of San Bernardino County,
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Gary Tomasetti Structure Rep.: Matt Bruce
Sample Information
DIME Sample ID: 2024-04-04-6
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3671 - Brea
Sample Organization Contact: (213) 841-3518
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 04/04/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/04/2024
The quantity of what the sample constitutes: 1
A brief description of the sample: Girder
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: SFS
Material Information
The concrete mix design number: 123
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 123
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Casting Line A1 Bulb Tee Girder B1
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
