Sample Record

Owner Lab

  • CT D04 - Petaluma Field Laboratory

DIME Sample ID 2023-09-12-12

Project Information

Project IdentifiersProject ID: 214998
DEA: 044H0504
EFIS: 0413000080
DIST-CO-RTE-PM04-SON-12-25.8-33.3
Award Date07/29/2022
Closeout DateNot set
Work DescriptionBRIDGE SCOUR MITIGATION
Location DescriptionSONOMA COUNTY NEAR SANTA ROSA AT SONOMA CREEK BRIDGE AND AT HOOKER CREEK BRIDGE
QA Service Level1 (Verified on 09/10/2020)

Sample Information

Sample Taken Date09/12/2023 Sample Unique Key12
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 sample6 - 4x8 concrete cylinders
The quantity of what the sample constitutes63 From where was the sample collectedJob Site
First name of sampler or witnessed byJohn Last name of sampler or witnessed byAjeakwa
Title of sampler Telephone number of sampler3108007053
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 identifier20-0306
Structure nameHooker Creek Bridge

Material Information

Material TypeConcrete The concrete mix design numberH7511503
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected138
Concrete batch plantShamrock Petaluma The fabricator/manufacturer designation for the samplePlant
A detailed description of where the material sample was collectedThe hopper of the concrete pump Where the material sample would have been placed if not sampledRetaining wall of Abutment 2
From Lot No. 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