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Sample Record for 2025-05-28-67

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 993454 DEA: 040K8004 EFIS: 0416000141 COOP: 042892 QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-13.7
Work Description: CONSTRUCT ROUNDABOUT, CURB RAMPS AND SW, SIGNAL AND LIGHTING SYSTEMS.
Location Description: MARIN COUNTY IN SAN RAFAEL AT FREITAS PARKWAY OVERCROSSING
Contractor Name: GHILOTTI BROS., INC.
Contractor Address: 525 JACOBY STREET, SAN RAFAEL CA 94901
Resident Engineer: Dawit Habteselassie Structure Rep.: Jeremy Light

Sample Information

DIME Sample ID: 2025-05-28-67
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3672 - Novato Field Office
Sample Organization Contact: (916) 621-8033
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/28/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/28/2025
The quantity of what the sample constitutes: 28.8
A brief description of the sample: 3 4x8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: RW-2 Footing at Freitas PKWY, San Rafael
The fabricator/manufacturer/facility name: Ecoterra Ready Mix

Material Information

The concrete mix design number: 6SK4K1X425F
The truck number from where the sample was collected: 1
The batch plant ticket number from where the sample was collected: 487
Concrete batch plant: On site
The fabricator/manufacturer designation for the sample: Ecoterra redy mix
A detailed description of where the material sample was collected: Back of the truck from the chute
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2025-05-28-67-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Submitted By Organization: CT SC - 3672 - Novato Field Office
Organization Address: 384 Bel Marin Keys Boulevard, Suite 200,
Organization City: Novato
Organization State: CA
Organization Zipcode: 94949
Organization Email: josh.velono@dot.ca.gov
Organization Phone: (916) 621-8033
Data has not been verified.

Test 2 of 3

DIME Test ID: 2025-05-28-67-2
Test Method: ASTM C143-15a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Submitted By Organization: CT SC - 3672 - Novato Field Office
Organization Address: 384 Bel Marin Keys Boulevard, Suite 200,
Organization City: Novato
Organization State: CA
Organization Zipcode: 94949
Organization Email: josh.velono@dot.ca.gov
Organization Phone: (916) 621-8033
Data has not been verified.

Test 3 of 3

DIME Test ID: 2025-05-28-67-3
Test Method: ASTM C39-17a: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Verified Date: 06/30/2025
Date Tested: 06/26/2025
Submitted By Organization: Kleinfelder - Hayward
Organization Address: 690 Walnut,
Organization City: vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: yannick.aranas@dot.ca.gov
Organization Phone: (916) 639-4315
General Comments for this Test: The Concrete was ready Mix on site and after slump test more water was added to achieve workability. These samples were taken with slump 2''.
Test Result Compliance:
Additional Comments When Verified:
Unit system used? US Units
Number of specimens 3
Test performed With no density determined
Capped in accordance with? ASTM C1231 - Unbonded Elastomeric Pad Cap
Average diameter of cylinder 1 4.00 in
Average diameter of cylinder 2 4.00 in
Average diameter of cylinder 3 4.00 in
Cross sectional area of cylinder 1 12.57 in^2
Cross sectional area of cylinder 2 12.57 in^2
Cross sectional area of cylinder 3 12.57 in^2
Compressive strength (to nearest 10 psi) 8960 psi
Maximum load on cylinder 1 113490 lb
Maximum load on cylinder 2 112032 lb
Maximum load on cylinder 3 112179 lb
Compressive strength of cylinder 1 9028.6 psi
Type of fracture pattern of cylinder 1 3
Compressive strength of cylinder 2 8912.6 psi
Compressive strength of cylinder 3 8924.3 psi
Type of fracture pattern of cylinder 2 3
Type of fracture pattern of cylinder 3 3
Comment on any defect in either specimen or caps (Max 250 Characters) no data
Correction factor for cylinder 1 1
Correction factor for cylinder 2 1
Correction factor for cylinder 3 1
Age of specimen 29 days
Age of specimen in hours no data