Sample Record

Owner Lab

  • CT HQ - QASI Bay Area Field Office

DIME Sample ID 2014-02-24-12005205

Project Information

Project IdentifiersProject ID: 208572
DEA: 100L3304
EFIS: 1000000100
COOP: 10355
Permit Numbers: 1012NMC0508
DIST-CO-RTE-PM10-STA-99-0.0/0.3
Award DateNot set
Closeout Date03/09/2020
Work DescriptionReconsteuct SR99/Kiernan Interchange
Location DescriptionCity of Salida, in STA County
QA Service Level1 (Verified on 03/25/2013)

Sample Information

Sample Taken Date02/24/2014 Sample Unique Key12005205
Will the laboratory/organization for which you are a member perform testing on this material sample?Yes Date that the sample was received by the laboratory/organization performing the testing02/25/2014
Sample typeInformational A brief description of the sampleMix Design K6090-621SCC
The quantity of what the sample constitutes2 concrete cylinders From where was the sample collectedSource
First name of sampler or witnessed byRicardo Last name of sampler or witnessed byMedina
Title of samplerQA Inspector Telephone number of samplerNot set
Laboratory sample identificationNot set Linked DIME Sample IDNot set
The fabricator/manufacturer/facility nameKieCon Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifierNot set
Structure namePCPS Wide Flange Girder No. G-3

Material Information

Material TypeConcrete The concrete mix design numberK6090-621SCC
The truck number from where the sample was collectedNot set The batch plant ticket number from where the sample was collectedunknown
Concrete batch plantNot set The fabricator/manufacturer designation for the sampleKieCon
A detailed description of where the material sample was collectedBy formwork at precast plant during pour inspection (Third Truck Load) Where the material sample would have been placed if not sampledNot set
From Lot No.Not set Bag Lot No.Not set

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

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Test File Attachments