Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993141 DEA: 060V1204 EFIS: 0616000207
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD-99-R6.9/R7.6
Work Description: Cottonwood Creek Bridge Replacement - REPLACE BRIDGES AND CONSTRUCT RETAINING WALLS.
Location Description: MADERA COUNTY NEAR MADERA FROM 0.4 MILE SOUTH OF COTTONWOOD CREEK BRIDGE TO 0.1 MILE NORTH OF AVENUE 12 OVERCROSSING
Contractor Name: Security Paving Company, Inc.
Contractor Address: 3075 Townsgate Road, Westlake Village CA 91361
Resident Engineer: Din Dadawalla Structure Rep.: Ye Yang
DIME Sample ID: 2024-09-20-17
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/20/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/21/2024
The quantity of what the sample constitutes: 105.5
A brief description of the sample: End and continuity diaphragms
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Builders Concrete Ready Mix Plant Sanger
The concrete mix design number: ND22023
The truck number from where the sample was collected: 9220
The batch plant ticket number from where the sample was collected: 1363658
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-09-20-17-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: CT D06 - Millbrook Field Laboratory
Organization Address: 1352 W. Olive Ave,
Organization City: Fresno
Organization State: CA
Organization Zipcode: 93728
Organization Email: tomas.silva@dot.ca.gov
Organization Phone: (559) 417-5341
Data has not been verified.
