Sample Record

Owner Labs

  • CT SC Sub-unit 3674-102
  • CT HQ - Sacramento Concrete Testing Laboratory

DIME Sample ID 2019-07-19-4

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 Date07/19/2019 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 testingNot set
Sample typeQuality Assurance A brief description of the sample2 6x12 concrete cylinders
The quantity of what the sample constitutes102 Cubic Yards From where was the sample collectedJob Site
First name of sampler or witnessed byP Last name of sampler or witnessed byLatasa
Title of samplerTEC Telephone number of sampler707-246-0441
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 identifier20-E0088
Structure nameRW 97

Material Information

Material TypeConcrete The concrete mix design number4201A
The truck number from where the sample was collected1413 The batch plant ticket number from where the sample was collected479605
Concrete batch plantShamrock Petaluma The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedCHUTE FROM TRUCK Where the material sample would have been placed if not sampledRW 97 Wall
From Lot No. Bag Lot No.

Submitted Tests

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