Sample Record

Owner Labs

  • CT SC Sub-unit 3672-104
  • CT HQ - Sacramento Concrete Testing Laboratory

DIME Sample ID 2018-11-17-4

Project Information

Project IdentifiersProject ID: 209384
DEA: 04264094
EFIS: 0400000735
COOP: 042531
DIST-CO-RTE-PM04-,SON--
Award Date01/21/2016
Closeout Date06/03/2020
Work DescriptionNot set
Location DescriptionNot set
QA Service Level1 (Verified on 06/03/2020)

Sample Information

Sample Taken Date11/17/2018 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 testing11/30/2018
Sample typeQuality Control A brief description of the sample6X12 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 samplerASR 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 nameSan Antonio Creek Bridge

Material Information

Material TypeConcrete The concrete mix design number3130
The truck number from where the sample was collected1443 The batch plant ticket number from where the sample was collected471494
Concrete batch plantShamrock Materials The fabricator/manufacturer designation for the sampleREADYMIX CONCRETE
A detailed description of where the material sample was collectedChute discharge into wheel barrel Where the material sample would have been placed if not sampledbridge barrier
From Lot No. Bag Lot No.

Submitted Tests

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