Sample Record for 2024-08-26-87
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994859 DEA: 021H5904 EFIS: 0216000025
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-43.5,57.0
Work Description: REPLACE CULVERTS WITH BRIDGES, STREAMBED RESTORATION, & LANDSCAPING.
Location Description: SISKIYOU COUNTY AT AND NEAR HAPPY CAMP AT 0.8 MILE WEST OF GORDON\\'S FERRY ROAD AND AT PORTUGUESE CREEK
Contractor Name: J.F. SHEA CONSTRUCTION, INC.
Contractor Address: 17400 CLEAR CREEK ROAD, REDDING, CA 96001
Resident Engineer: Nicholas Riddle Structure Rep.: Nicolas Jimenez
Sample Information
DIME Sample ID: 2024-08-26-87
TL Number from the TL Form:
Sample Submitted By Organization: Kie-Con, Incorporated - Antioch
Sample Organization Contact: (925) 331-7122
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/26/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/26/2024
The quantity of what the sample constitutes: 10CY
A brief description of the sample: QC Sampling Data
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kie-Con
Material Information
The concrete mix design number: K5570-23080
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 122255
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
Test 1 of 1
DIME Test ID: 2024-08-26-87-1
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 09/26/2024
Date Tested: 08/26/2024
Submitted By Organization: Kie-Con, Incorporated - Antioch
Organization Address: 3551 Wilbur Avenue,
Organization City: Antioch
Organization State: CA
Organization Zipcode: 94509
Organization Email: cesar.rodriguez3@kiewit.com
Organization Phone: (925) 302-3654
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
