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

Sample Record for 2016-11-03-11

Project Information

Project ID: 209384 DEA: 04264094 EFIS: 0400000735 COOP: 042531 QA Service Level: 1
Work Description:
Location Description:
Contractor Name: GHILOTTI BROS / RM HARRIS JV Contractor Address: 525 Jacoby Street
Resident Engineer: Richard Duncan Structure Rep.: Beaudoin, Brian

Sample Information

DIME Sample ID: 2016-11-03-11
TL Number from the TL Form:
Sample Submitted By Organization: CT SC Sub-unit 3674-102
Sample Organization Contact:
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 11/03/2016
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 30 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

Material Information

The concrete mix design number: 4100A
The truck number from where the sample was collected: 1412
The batch plant ticket number from where the sample was collected: 445667
Concrete batch plant: 04
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: CHUTE OF TRUCK
Where the material sample would have been placed if not sampled: Pier 4 Col 1
From Lot No.:
Bag Lot No.: