Sample Record

Owner Lab

  • CT HQ - QASI Bay Area Field Office

DIME Sample ID 2021-06-08-25

Project Information

Project IdentifiersProject ID: 215063
DEA: 032F5704
EFIS: 0300020615
DIST-CO-RTE-PM03-PLA-80-46.3/63.5
Award Date09/23/2020
Closeout Date08/11/2023
Work DescriptionReplace 4 Bridges (OC) on Highway 80 from Crystal Springs to Cisco Grove (Baxter, Drum Forebay)
Location DescriptionNot set
QA Service Level1 (Verified on 11/16/2020)

Sample Information

Sample Taken Date06/08/2021 Sample Unique Key25
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 testing06/08/2021
Sample typeQuality Assurance A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes2 - 6x12 cylinders From where was the sample collectedFabricator
First name of sampler or witnessed bySaman Last name of sampler or witnessed byBarzegari
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameKie-Con Antioch Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design number000000000000
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected000000000000
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedKie-Con Antioch Where the material sample would have been placed if not sampled
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
No results found.

Sample File Attachments

File NameExtensionDate UploadedActions
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Test File Attachments