Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000259 DEA: 050N74V4 EFIS: 0522000043
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-9.2/9.7
Work Description:
Location Description: FOR CONSTRUCTION ON STATE HIGHWAY IN SANTA BARBARA COUNTY AT MONTECITO FROM 0.2 MILE NORTH OF SHEFFIELD DRIVE UNDERCROSSING TO 0.3 MILE SOUTH OF SAN YSIDRO ROAD OVERCROSSING
Contractor Name: Granite Construction Company
Contractor Address: P.O. Box 6744, Santa Barbara, CA 93160
Resident Engineer: Taylor Merlo Structure Rep.: Emiliano Berntsen
DIME Sample ID: 2024-08-28-114
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: 08/28/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/28/2024
The quantity of what the sample constitutes: 47CY
A brief description of the sample: QC concrete sampling
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: KIE CON
The concrete mix design number: K5065-23137
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 122116
Concrete batch plant:
The fabricator/manufacturer designation for the sample: QC concrete sampling
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.:
DIME Test ID: 2024-08-28-114-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 10/08/2024
Date Tested: 08/28/2024
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:
