Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210160 DEA: 101E2204 EFIS: 1015000011 COOP: 10439
QA Service Level: 2
DIST-CO-RTE-PM: 10-SJ-580-13.3/13.8
Work Description: Widen existing road under I-580 to accommodate ramp widening and additional left turn lanes . Proposes to replace existing two lane bridge over the adjacent California Aqueduct on the east side of the Interchange and add two additional lanes
Location Description: Between I-580 and Old Schulte Road
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Rob Shackelford Structure Rep.: Howard Zabell
DIME Sample ID: 2024-11-06-100
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: 11/06/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/06/2024
The quantity of what the sample constitutes: Concrete Testing
A brief description of the sample: Testing Documents
From where was the sample collected: Fabricator
Laboratory sample identification: Kie-Con
Structure unique identifier: 29-0024
Structure name: Patterson Pass
The fabricator/manufacturer/facility name: Kie-Con
The concrete mix design number: K5080-24046
The truck number from where the sample was collected: 1
The batch plant ticket number from where the sample was collected: 123280
Concrete batch plant: Kiecon
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
