Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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
DIME Sample ID: 2025-10-13-33
TL Number from the TL Form:
Sample Submitted By Organization: Construction Testing Services
Sample Organization Contact: (925) 351-6905
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 10/13/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/15/2025
The quantity of what the sample constitutes: 7 CY
A brief description of the sample: 4 x 8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Shamrock
The concrete mix design number: D20115E1
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 925850
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Point of Discharge
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-10-13-33-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C1231 - Unbonded Elastomeric Pad Cap Cured in accordance with ASTM C511
Submitted By Organization: Construction Testing Services
Organization Address: 2118 Rheem Drive,
Organization City: Pleasanton
Organization State: CA
Organization Zipcode: 94588
Organization Email: rring@cts-1.com
Organization Phone: (925) 351-6905
Data has not been verified.
