Sample Record

Owner Lab

  • CT HQ - QASI Bay Area Field Office

DIME Sample ID 2018-05-09-10

Project Information

Project IdentifiersProject ID: 212680
DEA: 024F5504
EFIS: 0213000005
DIST-CO-RTE-PM02-SIS-89-20.9 - 21.2
Award Date11/14/2017
Closeout Date05/15/2019
Work DescriptionBRIDGE REPLACEMENT WITH PRE-CAST I-GIRDER AND RECONSTRUCT HIGHWAY
Location DescriptionSISKIYOU COUNTY NEAR MCCLOUD FROM 0.2 MILE SOUTH TO 0.2 MILE NORTH OF MUD CREEK BRIDGE
QA Service Level1 (Verified on 02/12/2018)

Sample Information

Sample Taken Date05/09/2018 Sample Unique Key10
Will the laboratory/organization for which you are a member perform testing on this material sample?Yes Date that the sample was received by the laboratory/organization performing the testing05/11/2018
Sample typeQuality Assurance A brief description of the sampleConcrete Cylinder 6 x 12
The quantity of what the sample constitutes2 From where was the sample collectedFabricator
First name of sampler or witnessed bystacey Last name of sampler or witnessed bydavis
Title of samplerUnknown Telephone number of samplerUnknown
Laboratory sample identificationUnknown Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility namekiecon Transportation Laboratory (TL) NumberUnknown
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierUnknown
Structure nameUnknown

Material Information

Material TypeConcrete The concrete mix design numberk5565545R1
The truck number from where the sample was collectedUnknown The batch plant ticket number from where the sample was collectedunk
Concrete batch plantUnknown The fabricator/manufacturer designation for the sampleUnknown
A detailed description of where the material sample was collectedfabricator Where the material sample would have been placed if not sampledUnknown
From Lot No.Unknown Bag Lot No.Unknown

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2018-05-09-10-1ASTM C39-17a: Standard Test Method for Compressive Strength of Cylindrical Concrete SpecimensWilliam Sommer, CT HQ - QASI Bay Area Field Office06/06/2018William Sommer
No
Info

Sample File Attachments

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Test File Attachments


DIME Test ID: 2018-05-09-10-1 ASTM C39-17a