Sample Record

Owner Labs

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

DIME Sample ID 2019-06-26-3

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 Date06/26/2019 Sample Unique Key3
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 testing06/28/2019
Sample typeQuality Assurance A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes2 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 nameRetaining Wall 97

Material Information

Material TypeConcrete The concrete mix design number4201a
The truck number from where the sample was collected1445 The batch plant ticket number from where the sample was collected478502
Concrete batch plantShamrock Materials The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedChute Where the material sample would have been placed if not sampledRetaining Wall Footing
From Lot No. Bag Lot No.

Submitted Tests

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