Sample Record

Owner Lab

  • CT HQ - QASI Sacramento Field Office

DIME Sample ID 2022-04-13-13

Project Information

Project IdentifiersProject ID: 215063
DEA: 032F5704
EFIS: 0300020615
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 Date04/13/2022 Sample Unique Key13
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 testing04/14/2022
Sample typeQuality Assurance A brief description of the sample4x8 concrete cylinders
The quantity of what the sample constitutes6 x (4" x 8") cylinders From where was the sample collectedFabricator
First name of sampler or witnessed byChristopher Last name of sampler or witnessed byNutting
Title of samplerQuality Assurance Inspector Telephone number of sampler6469510671
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 identifier31-19-0207
Structure nameReplace 4 Bridges from Crystal Springs to Cisco Grove

Material Information

Material TypeConcrete The concrete mix design numberK5670-100 CpR6
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected114327
Concrete batch plantKieCon The fabricator/manufacturer designation for the sampleMix
A detailed description of where the material sample was collectedConcrete sample from wheelbarrow Where the material sample would have been placed if not sampledprecast girder
From Lot No.load id 115440 Bag Lot No.

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