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: 2025-01-01-12
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: 01/01/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/03/2024
The quantity of what the sample constitutes: 25
A brief description of the sample: Concrete
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name: Pile Number 1 Abut 4
The fabricator/manufacturer/facility name: MSC
The concrete mix design number: KCIDH
The truck number from where the sample was collected: First Truck
The batch plant ticket number from where the sample was collected: Not applicable
Concrete batch plant: Onsite
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.:
DIME Test ID: 2025-01-01-12-1
Test Method: ASTM C39-21: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Verified Date: 01/30/2025
Date Tested: 01/01/2025
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
General Comments for this Test: n/a
Test Result Compliance:
Additional Comments When Verified:
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Unit system used?
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US Units
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Number of specimens
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2
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Test performed
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With density determined by dimension measurements
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Average cylinder density (to nearest 1 pcf)
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150.1 lb/ft^3
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Average diameter of cylinder 1
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4.00 in
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Average diameter of cylinder 2
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4.00 in
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Comment on any defect in either specimen or caps (Max 250 Characters)
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N/A
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Serial number of delivery ticket, if available
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3134
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