Sample Record for 2025-04-23-8
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212470 DEA: 044A1304 EFIS: 0400001106 COOP: 042718
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-101-18.5/18.5
Work Description: CONSISTS OF MODIFICATION AND RECONSTRUCTION OF THE EXISTING US 101/HEARN AVENUE INTERCHANGE IN SONOMA COUNTY, INCLUDING REPLACING THE EXISTING TWO-LANE HEARN AVENUE OVERCROSSING WITH A NEW OVERCROSSING, AND MODIFYING THE SOUTHBOUND OFF-RAMP IN CITY
Location Description: IN SONOMA COUNTY.
Contractor Name: Ghilotti Construction Company, Inc. (Chase McPhaul)
Contractor Address: 246 Ghilotti Avenue, Santa Rosa, CA 95407
Resident Engineer: Seyed "Syd" Valeh Structure Rep.: Anthony "Tony" Tierra; Sardar Chalabe
Sample Information
DIME Sample ID: 2025-04-23-8
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3672 - Santa Rosa
Sample Organization Contact: (510) 774-6009
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/23/2025
Date that the sample was received by the laboratory/organization performing the testing: 03/24/2025
The quantity of what the sample constitutes: 80CY
A brief description of the sample: cement-1
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Superior Supplies
Material Information
The concrete mix design number: 675CR1
The truck number from where the sample was collected: 57
The batch plant ticket number from where the sample was collected: 309611
Concrete batch plant:
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.:
Test Results
Test 1 of 2
DIME Test ID: 2025-04-23-8-2
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Submitted By Organization: CT SC - 3672 - Santa Rosa
Organization Address: 4030 Occidental, Building B,
Organization City: Santa Rosa
Organization State: CA
Organization Zipcode: 95401
Organization Email: james.cook@dot.ca.gov
Organization Phone: (707) 974-2571
Data has not been verified.
Test 2 of 2
DIME Test ID: 2025-04-23-8-3
Test Method: ASTM C143-15a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Submitted By Organization: CT SC - 3672 - Santa Rosa
Organization Address: 4030 Occidental, Building B,
Organization City: Santa Rosa
Organization State: CA
Organization Zipcode: 95401
Organization Email: james.cook@dot.ca.gov
Organization Phone: (707) 974-2571
Data has not been verified.
