Sample Record

Owner Lab

  • CT SC - 3672 - Petaluma

DIME Sample ID 2018-10-18-7

Project Information

Project IdentifiersProject ID: 213002
DEA: 042640N4
EFIS: 0412000649
DIST-CO-RTE-PM04-MRN,SON-101-MRN27.0/27.6SON0.0/4.5
Award Date04/09/2018
Closeout Date03/12/2021
Work DescriptionCONSTRUCT HOV LANES
Location DescriptionMARIN AND SONOMA COUNTIES IN AND NEAR PETALUMA FROM 0.6 MILE SOUTH OF SAN ANTONIO CREEK BRIDGE TO 0.3 MILE SOUTH OF EAST WASHINGTON STREET OVER CROSSING
QA Service Level1 (Verified on 04/13/2018)

Sample Information

Sample Taken Date10/18/2018 Sample Unique Key7
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 testing10/26/2018
Sample typeQuality Control A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes6x12 Cylinders From where was the sample collectedJob Site
First name of sampler or witnessed byMelvin Last name of sampler or witnessed byDumlao
Title of samplerAssistant Structure Representative Telephone number of sampler1-707-333-4263
Laboratory sample identificationNone 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 identifierRetaining Wall 123
Structure nameRetaining Wall 123

Material Information

Material TypeConcrete The concrete mix design number4201A
The truck number from where the sample was collected1435 The batch plant ticket number from where the sample was collected470623
Concrete batch plantShamrock Materials The fabricator/manufacturer designation for the sampleShamrock Materials
A detailed description of where the material sample was collectedCHUTE FROM TRUCK Where the material sample would have been placed if not sampledRetaining Wall
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
No results found.

Sample File Attachments

File NameExtensionDate UploadedActions
No results found.

Test File Attachments