Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001249 DEA: 031N5504 EFIS: 0325000797
QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-70-35/36
Work Description: Major Damage Restoration
Location Description: BUT 70 Viaduct
Contractor Name: Steelhead Constructors (Justin Babcock)
Contractor Address: 2940 INNSBRUCK DRIVE, REDDING CA 96003
Resident Engineer: Adam Scardaci Structure Rep.: Adam Scardaci
DIME Sample ID: 2025-06-03-24
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3667 - Chico
Sample Organization Contact: (530) 713-7871
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 06/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/03/2025
The quantity of what the sample constitutes: 9 CY
A brief description of the sample: Bent 9 Left CIDH Pile Mix
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 12-0209
Structure name: Concow Sidehill Viaduct
The fabricator/manufacturer/facility name: Mathews Ready Mix
The concrete mix design number: 072335F25O
The truck number from where the sample was collected: 841
The batch plant ticket number from where the sample was collected: 16033350
Concrete batch plant: Mathews Readymix Oroville
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: CHUTE FROM TRUCK
Where the material sample would have been placed if not sampled: Bent 9 Left CIDH Pile
From Lot No.:
Bag Lot No.:
