Sample Record
Owner Labs
- CT SC - 3672 - Petaluma
- CT HQ - Sacramento Concrete Testing Laboratory
DIME Sample ID 2019-06-26-3
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 213002 DEA: 042640N4 EFIS: 0412000649 |
|---|---|
| DIST-CO-RTE-PM | 04-MRN,SON-101-MRN27.0/27.6SON0.0/4.5 |
| Award Date | 04/09/2018 |
| Closeout Date | 03/12/2021 |
| Work Description | CONSTRUCT HOV LANES |
| Location Description | MARIN 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 Level | 1 (Verified on 04/13/2018) |
Sample Information
| Sample Taken Date | 06/26/2019 | Sample Unique Key | 3 |
|---|---|---|---|
| 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 testing | 06/28/2019 |
| Sample type | Quality Assurance | A brief description of the sample | 6x12 concrete cylinders |
| The quantity of what the sample constitutes | 2 cylinders | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Harry | Last name of sampler or witnessed by | Suryantoro |
| Title of sampler | ASR | Telephone number of sampler | 1-707-333-4263 |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Shamrock Materials | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name | Retaining Wall 97 |
Material Information
| Material Type | Concrete | The concrete mix design number | 4201a |
|---|---|---|---|
| The truck number from where the sample was collected | 1445 | The batch plant ticket number from where the sample was collected | 478502 |
| Concrete batch plant | Shamrock Materials | The fabricator/manufacturer designation for the sample | |
| A detailed description of where the material sample was collected | Chute | Where the material sample would have been placed if not sampled | Retaining Wall Footing |
| From Lot No. | Bag Lot No. |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||