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Sample Record for 2016-09-09-7

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

Project Information

Project ID: 209384 DEA: 04264094 EFIS: 0400000735 COOP: 042531 QA Service Level: 1
Work Description:
Location Description:
Contractor Address: 525 Jacoby Street, San Rafael, CA 94901
Resident Engineer: Richard Duncan Structure Rep.: Brian Beaudoin

Sample Information

DIME Sample ID: 2016-09-09-7
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3674 - Pacifica 2
Sample Organization Contact: (510) 714-7639
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/09/2016
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 128 CY
A brief description of the sample: 2 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 270119
Structure name: San Antonio Creek Bridge
The fabricator/manufacturer/facility name: Shamrock

Material Information

The concrete mix design number: 4201a
The truck number from where the sample was collected: 1410
The batch plant ticket number from where the sample was collected: 443595
Concrete batch plant: 04
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: CHUTE FROM TRUCK
Where the material sample would have been placed if not sampled: CIDH Pile Pier 2 Col 1
From Lot No.:
Bag Lot No.:

Test Results