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Sample Record for 2016-08-30-6

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 210814 DEA: 041J3204 EFIS: 0414000190 QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-116-13.7
Work Description: REPLACE RETAINING WALL, DRAINAGE, AND HMA RESURFACING.
Location Description: REPLACE RETAINING WALL, DRAINAGE, AND HMA RESURFACING.
Contractor Name: GORDON N. BALL, INC.
Contractor Address: 333 Camille Ave., Alamo, CA 94507
Resident Engineer: Scott Hislop Structure Rep.: Law, Clifford

Sample Information

DIME Sample ID: 2016-08-30-6
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT SC Sub-unit 3676-106
Sample Organization Contact:
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 08/30/2016
Date that the sample was received by the laboratory/organization performing the testing: 09/07/2016
The quantity of what the sample constitutes: 23.5 CY
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: Unknown
Structure unique identifier: 041J3204
Structure name: Retaining Wall Pocket Creek
The fabricator/manufacturer/facility name: Canyon Rock Co Inc

Material Information

The concrete mix design number: 72102503F
The truck number from where the sample was collected: 253
The batch plant ticket number from where the sample was collected: 1154543
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: from mix truck
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.