Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001142 DEA: 01461704 EFIS: 0116000032
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-25.4
Work Description: WATER TREATMENT SYSTEM UPGRADE AND REPLACE ASPHALT CONCRETE SURFACING.
Location Description: HUMBOLDT COUNTY NEAR BRIDGEVILLE AT THE BRIDGEVILLE MAINTENANCE STATION
Contractor Name: NICO ENGINEERING, INC.
Contractor Address: 1409 colin street, san Pablo, CA, 94806
Resident Engineer: cody Long Structure Rep.: Unknown
DIME Sample ID: 2025-11-21-4
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 11/21/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/21/2025
The quantity of what the sample constitutes: 9 CY
A brief description of the sample: Type II-V Cement & GGBF
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mercer Fraser - Fortuna
The concrete mix design number: MF CL 1 .40 SLAG AE
The truck number from where the sample was collected: 694
The batch plant ticket number from where the sample was collected: 51883-1
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Sampled from chute of ready mix truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-11-21-4-1
Test Method: CTM 556-June 2010: Method of Test for Slump of Fresh Portland Cement Concrete
Verified Date: 11/21/2025
Date Tested: 11/21/2025
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1050 River Ranch Road,
Organization City: Fortuna
Organization State: California
Organization Zipcode: 95540
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2025-11-21-4-2
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 11/21/2025
Date Tested: 11/21/2025
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1050 River Ranch Road,
Organization City: Fortuna
Organization State: California
Organization Zipcode: 95540
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2025-11-21-4-3
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 12/19/2025
Date Tested: 12/19/2025
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1050 River Ranch Road,
Organization City: Fortuna
Organization State: California
Organization Zipcode: 95540
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test: 12/19/25 28 Day Break
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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6960 psi
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Maximum load on cylinder 1
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85708 lb
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Maximum load on cylinder 2
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88498 lb
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Maximum load on cylinder 3
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88233 lb
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Type of fracture pattern of cylinder 1
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5
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Type of fracture pattern of cylinder 2
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5
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Type of fracture pattern of cylinder 3
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5
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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 data0 hours
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