Sample Record
Owner Labs
- CT SC - 3674 - Pacifica 2
- CT HQ - Sacramento Concrete Testing Laboratory
DIME Sample ID 2015-07-13-3
Project Information
Project Identifiers | Project ID: 7463 DEA: 042640U4 EFIS: 0412000195 |
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DIST-CO-RTE-PM | 04-SON-101-0.9/3.6 |
Award Date | 11/02/2012 |
Closeout Date | 06/03/2020 |
Work Description | CONSTRUCT PETALUMA BLVD SOUTH INTERCHANGE, REPLACE PETALUMA RIVER BR |
Location Description | SONOMA COUNTY IN AND NEAR PETALUMA FROM GUNN DRIVE TO ROUTE 101/116 SEPARATION AND OVERHEAD |
QA Service Level | 1 (Verified on 09/11/2012) |
Sample Information
Sample Taken Date | 07/13/2015 | Sample Unique Key | 3 |
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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 testing | 07/23/2015 |
Sample type | Quality Assurance | A brief description of the sample | 2 6x12 concrete cylinders |
The quantity of what the sample constitutes | 36 CY PT Blockouts End Diaphragms Closure | From where was the sample collected | Job Site |
First name of sampler or witnessed by | Harry | Last name of sampler or witnessed by | Suryantaro |
Title of sampler | TEC | Telephone number of sampler | 510) 385-7179 |
Laboratory sample identification | Unknown | Linked DIME Sample ID | Unknown |
The fabricator/manufacturer/facility name | Shamrock | Transportation Laboratory (TL) Number | Unknown |
Inspector Lot Number from the Transportation Laboratory (TL) Form | Unknown | Structure unique identifier | 20195 |
Structure name | Petaluma River Bridge |
Material Information
Material Type | Concrete | The concrete mix design number | 4100A |
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The truck number from where the sample was collected | 1293 | The batch plant ticket number from where the sample was collected | 428011 |
Concrete batch plant | 04 | The fabricator/manufacturer designation for the sample | 4100A |
A detailed description of where the material sample was collected | Back of Truck | Where the material sample would have been placed if not sampled | PT Blockouts End Diaphragms St 3 |
From Lot No. | Not set | Bag Lot No. | Not set |
Submitted Tests
Sample File Attachments
File Name | Extension | Date Uploaded | Actions |
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No results found. |
Test File Attachments
DIME Test ID: 2015-07-13-3-1 ASTM C39-10 (Verified)