Sample Record for 2024-07-19-95
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212470 DEA: 044A1304 EFIS: 0400001106 COOP: 042718
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-101-18.5/18.5
Work Description: CONSISTS OF MODIFICATION AND RECONSTRUCTION OF THE EXISTING US 101/HEARN AVENUE INTERCHANGE IN SONOMA COUNTY, INCLUDING REPLACING THE EXISTING TWO-LANE HEARN AVENUE OVERCROSSING WITH A NEW OVERCROSSING, AND MODIFYING THE SOUTHBOUND OFF-RAMP IN CITY
Location Description: IN SONOMA COUNTY.
Contractor Name: Ghilotti Construction Company, Inc. (Chase McPhaul)
Contractor Address: 246 Ghilotti Avenue, Santa Rosa, CA 95407
Resident Engineer: Seyed "Syd" Valeh Structure Rep.: Anthony "Tony" Tierra; Sardar Chalabe
Sample Information
DIME Sample ID: 2024-07-19-95
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: 07/19/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/19/2024
The quantity of what the sample constitutes: 82
A brief description of the sample: QC Sampling Date
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: KieCon
Material Information
The concrete mix design number: CA270-V81
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 121731
Concrete batch plant: Kie Con
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
