Sample Record

Owner Lab

  • CT SC Sub-unit 3672-104

DIME Sample ID 2017-05-31-4

Project Information

Project IdentifiersProject ID: 210871
DEA: 044G4604
EFIS: 0412000480
DIST-CO-RTE-PM04-MRN-101-1.5/14.0
Award Date01/28/2016
Closeout Date10/17/2019
Work DescriptionREMOVE EXISTING AND CONSTRUCT NEW BRIDGE RAILINGS.
Location DescriptionIN MARIN COUNTY, AT VARIOUS LOCATION, FROM SPENCER AVE OVERCROSSING TO NORTH BRANCHGALLINAS CREEK BRIDGE
QA Service Level1 (Verified on 01/12/2016)

Sample Information

Sample Taken Date05/31/2017 Sample Unique Key4
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testing06/08/2017
Sample typeQuality Assurance A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes2 6x12 concrete cylinders From where was the sample collectedJob Site
First name of sampler or witnessed byHarry Last name of sampler or witnessed bySuryantoro
Title of samplerTransportation Engineer Telephone number of sampler1-707-333-4263
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameShamrock Materials Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure nameCorte Madera Creek Bridge

Material Information

Material TypeConcrete The concrete mix design number4700B
The truck number from where the sample was collected1208 The batch plant ticket number from where the sample was collected154782
Concrete batch plant1 The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedMix Truck Chute Where the material sample would have been placed if not sampledCorbel and Overhang Bridge
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
No results found.