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Sample Record for 2025-10-20-4

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

Project Information

Project ID: 1000731 DEA: 042Q4404 EFIS: 0419000013 QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-121-6.5,8.4
Work Description: REMOVE BR AND AC SURF, CONSTRUCT BR DECK, RAILING AND POLYESTER CONC.
Location Description: SONOMA COUNTY NEAR SONOMA AT YELLOW CREEK BRIDGE AND AT ARROYO SECO BRIDGE
Contractor Name: GORDON N. BALL, INC.
Contractor Address: Unknown
Resident Engineer: Fabio La Serna Structure Rep.: Jeremy Light

Sample Information

DIME Sample ID: 2025-10-20-4
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: Acceptance
Type of Material: Polyester
Sample Taken Date: 10/20/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2025
The quantity of what the sample constitutes: 3360 sqft
A brief description of the sample: Polyester Overlay
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 20-0023
Structure name: Arroyo Seco
The fabricator/manufacturer/facility name: Dees Burke

Material Information

Mfg. Lot Number(s): 111
Batch number: 112
Mix number: 1112
Test results on following page(s): 1

Test Results

Test 1 of 1

DIME Test ID: 2025-10-20-4-1
Test Method: CTM 552-December 2013: Method of Test for Relative Compaction of Polymer Concrete Utilizing Nuclear Gages
Verified Date: 11/24/2025
Date Tested: 10/23/2025
Submitted By Organization: CT D04 - Petaluma Field Laboratory
Organization Address: 5675 Gibraltar Drive,
Organization City: Pleasanton
Organization State: CA
Organization Zipcode: 94588
Organization Email: glenn.cea@dot.ca.gov
Organization Phone: (510) 385-6841
General Comments for this Test: This is for CTM 552 Polyester overlay. The schedule date for overlay is 10/24 tentatively, depending on the weather. Will update if anything changes. Let us know if you have any questions.
Test Result Compliance:
Additional Comments When Verified:
Gage No. 688
Time of test 12:00 HH:MM
Standard Density 2.15 g/cc
In-Place Density 2.09 g/cc
Percent Relative Compaction 97 %