Sample Record

Owner Lab

  • CT SC - 3676 - 106

DIME Sample ID 2016-08-30-5

Project Information

Project IdentifiersProject ID: 210814
DEA: 041J3204
EFIS: 0414000190
DIST-CO-RTE-PM04-SON-116-13.7
Award Date03/08/2016
Closeout Date12/19/2017
Work DescriptionREPLACE RETAINING WALL, DRAINAGE, AND HMA RESURFACING.
Location DescriptionREPLACE RETAINING WALL, DRAINAGE, AND HMA RESURFACING.
QA Service Level1 (Verified on 09/18/2015)

Sample Information

Sample Taken Date08/30/2016 Sample Unique Key5
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 testing09/07/2016
Sample typeAcceptance A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes23.5 CY From where was the sample collectedJob Site
First name of sampler or witnessed byPamela Last name of sampler or witnessed byGagnier
Title of samplerTE Telephone number of sampler707-694-4751
Laboratory sample identificationUnknown Linked DIME Sample ID01-07-1/2,2/2-424
The fabricator/manufacturer/facility nameCanyon Rock Co Inc Transportation Laboratory (TL) NumberUnknown
Inspector Lot Number from the Transportation Laboratory (TL) Form256424 Structure unique identifier041J3204
Structure nameRetaining Wall Pocket Creek

Material Information

Material TypeConcrete The concrete mix design number72102503F
The truck number from where the sample was collected253 The batch plant ticket number from where the sample was collected1154543
Concrete batch plantUnknown The fabricator/manufacturer designation for the sampleUnknown
A detailed description of where the material sample was collectedfrom mix truck Where the material sample would have been placed if not sampledUnknown
From Lot No.Unknown Bag Lot No.Unknown

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