Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000938 DEA: 101U1004 EFIS: 1025000094
QA Service Level: 1
DIST-CO-RTE-PM: 10---
Work Description:
Location Description:
Contractor Name: Viking Construction Company
Contractor Address: P O BOX 1508, RANCHO CORDOVE, CA 95742-1508
Resident Engineer: Chris Hanson Structure Rep.: Daniel Laureno
DIME Sample ID: 2025-04-03-32
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California Corporation - Lathrop
Sample Organization Contact: (209) 249-4700
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 04/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/03/2025
The quantity of what the sample constitutes: 1 Bucket of 1/2", 1 Bucket of 3/8", One Bucket of Sand
A brief description of the sample: 1 Bucket of 1/2", 1 Bucket of 3/8", One Bucket of Sand
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Con-Fab California, LLC
Source Identification (SMARA, name of Pit or Job Site): Con-Fab California, LLC
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Plant Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2025-04-03-32-1
Test Method: ASTM C566-19: Standard Test Method for Total Evaporable Moisture Content of Aggregate by Drying
Verified Date: 04/06/2025
Date Tested: 04/03/2025
Submitted By Organization: Con-Fab California Corporation - Lathrop
Organization Address: 1910 Lathrop Road,
Organization City: Lathrop
Organization State: CA
Organization Zipcode: 95330
Organization Email: dannyc@confabca.com
Organization Phone: (209) 249-4717
General Comments for this Test: Sand: 3.00%
1/2": 0.36%
3/8": 0.36%
Test Result Compliance:
Additional Comments When Verified:
|
Total evaporable moisture content
|
3 %
|
