Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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
DIME Sample ID: 2025-06-13-41
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3672 - Petaluma
Sample Organization Contact: (510) 3939273
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 06/13/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/13/2025
The quantity of what the sample constitutes: 19.92
A brief description of the sample: 1x 4 Pcc Aggregate and sand
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: RW-2 Stem wall at Freitas PKWY, San Rafael
The fabricator/manufacturer/facility name: Ecoterra Ready Mix
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: 497
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: from back of the truck chute
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-06-13-41-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 06/24/2025
Date Tested: 06/13/2025
Submitted By Organization: CT SC - 3672 - Petaluma
Organization Address: 756 Francisco Boulevard West,
Organization City: San Rafael
Organization State: CA
Organization Zipcode: 94901
Organization Email: jeremy.light@dot.ca.gov
Organization Phone: (510) 393-9273
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
DIME Test ID: 2025-06-13-41-2
Test Method: ASTM C143-15a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 06/24/2025
Date Tested: 06/13/2025
Submitted By Organization: CT SC - 3672 - Petaluma
Organization Address: 756 Francisco Boulevard West,
Organization City: San Rafael
Organization State: CA
Organization Zipcode: 94901
Organization Email: jeremy.light@dot.ca.gov
Organization Phone: (510) 393-9273
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
DIME Test ID: 2025-06-13-41-3
Test Method: ASTM C39-17a: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Verified Date: 07/11/2025
Date Tested: 07/11/2025
Submitted By Organization: Quality Assurance Engineering, Inc dba Consolidated Engineering Laboratories
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:
Test Result Compliance:
Additional Comments When Verified:
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Unit system used?
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US Units
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Number of specimens
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3
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Test performed
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With no density determined
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Capped in accordance with?
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ASTM C1231 - Unbonded Elastomeric Pad Cap
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Average diameter of cylinder 1
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4.00 in
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Average diameter of cylinder 2
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4.00 in
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Average diameter of cylinder 3
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4.00 in
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Cross sectional area of cylinder 1
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12.57 in^2
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Cross sectional area of cylinder 2
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12.57 in^2
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Cross sectional area of cylinder 3
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12.57 in^2
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Compressive strength (to nearest 10 psi)
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8800 psi
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Maximum load on cylinder 1
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102820 lb
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Maximum load on cylinder 2
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113880 lb
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Maximum load on cylinder 3
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115190 lb
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Compressive strength of cylinder 1
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8179.8 psi
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Type of fracture pattern of cylinder 1
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2
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Compressive strength of cylinder 2
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9059.7 psi
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Compressive strength of cylinder 3
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9163.9 psi
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Type of fracture pattern of cylinder 2
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3
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Type of fracture pattern of cylinder 3
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2
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Comment on any defect in either specimen or caps (Max 250 Characters)
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no data
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Correction factor for cylinder 1
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1
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Correction factor for cylinder 2
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1
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Correction factor for cylinder 3
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1
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Age of specimen
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28 days
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Age of specimen in hours
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no data
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