Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995524 DEA: 021H3604 EFIS: 0216000040
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-76.8/78.0
Work Description: REPLACE BRIDGE.
Location Description: SISKIYOU COUNTY NEAR HORSE CREEK FROM 0.4 MILE WEST OF KLAMATH RIVER BRIDGE TO 2.0 MILES WEST OF KOHL CREEK
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Nicholas Riddle Structure Rep.: Mike Sears
DIME Sample ID: 2024-09-09-120
TL Number from the TL Form:
Sample Submitted By Organization: Myers and Sons Construction
Sample Organization Contact: (650) 864-2057
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 09/09/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/09/2024
The quantity of what the sample constitutes: 57.4 CF
A brief description of the sample: Concrete cylinder samples 4" dia x 8" long
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name: Horse Creek CIDH Abutment 4
The fabricator/manufacturer/facility name: Myers and Sons Construction
The concrete mix design number: KCIDH
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 001
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Load 1
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-09-09-120-1
Test Method: CTM 518-June 2010: Method of Test for Unit Weight of Fresh Concrete
Submitted By Organization: Myers and Sons Construction
Organization Address: 45 Morrison Avenue,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95838
Organization Email: vvincent@myers-sons.com
Organization Phone: (650) 864-2057
Data has not been verified.
