Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000403 DEA: 120K91U4 EFIS: 1222000031
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-91-R9.2/R11.4
Work Description: CONST BRIDGES, RW, SW, PAVEMENT, DRAINAGE AND ELECTRICAL SYSTEMS.
Location Description: ORANGE COUNTY IN ANAHEIM FROM 0.9 MILE WEST TO 1.3 MILES EAST OF LAKEVIEW AVENUE OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 16700 Valley View Avenue Suite 300
Resident Engineer: Steve Kinaly Structure Rep.: Wei-Jen Lee
DIME Sample ID: 2026-03-06-15
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California Corporation - Shafter
Sample Organization Contact: (661) 630-7162
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 03/06/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/06/2026
The quantity of what the sample constitutes: 5.0 CY
A brief description of the sample: T-II/V Cement
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Con-Fab California, LLC - Shafter
The concrete mix design number: SCC-S9.8-FG
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 6995
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Sampled from wheelbarrow collected 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: 2026-03-06-15-1
Test Method: ASTM C138-17a: Standard Test Method for Density (Unit Weight), Yield, and Air Content (Gravimetric) of Concrete
Verified Date: 03/09/2026
Date Tested: 03/06/2026
Submitted By Organization: Con-Fab California Corporation - Shafter
Organization Address: 701 Golds Avenue,
Organization City: Shafter
Organization State: CA
Organization Zipcode: 93263
Organization Email: benjamina@confabca.com
Organization Phone: (661) 630-3283
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Identification of concrete represented by the sample
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CAWF 72 PT Girder
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Volume of the measure
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0.25 ft^3
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Density of concrete
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154.2 lb/ft^3
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Yield of concrete
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no data
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Relative yield of the batch
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no data
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Cement content
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no data
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Air content
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no data
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DIME Test ID: 2026-03-06-15-2
Test Method: ASTM C231-17a: Standard Test Method for Air Content of Freshly Mixed Concrete by the Pressure Method
Verified Date: 03/09/2026
Date Tested: 03/06/2026
Submitted By Organization: Con-Fab California Corporation - Shafter
Organization Address: 701 Golds Avenue,
Organization City: Shafter
Organization State: CA
Organization Zipcode: 93263
Organization Email: benjamina@confabca.com
Organization Phone: (661) 630-3283
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2026-03-06-15-3
Test Method: ASTM C1611-21: Standard Test Method for Slump Flow of Self-Consolidating Concrete
Verified Date: 03/09/2026
Date Tested: 03/06/2026
Submitted By Organization: Con-Fab California Corporation - Shafter
Organization Address: 701 Golds Avenue,
Organization City: Shafter
Organization State: CA
Organization Zipcode: 93263
Organization Email: benjamina@confabca.com
Organization Phone: (661) 630-3283
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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What unit system is used for measurements?
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inches
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Slump Flow
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25 in
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Filling the mold procedure
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Filling Procedure B (Inverted Mold)
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Diameter 1
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25 in
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Diameter 2
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25 in
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Visual Stability Index
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no data0
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DIME Test ID: 2026-03-06-15-4
Test Method: CTM TEMP1-16: Test Method for Monitoring Precast Concrete Curing Temperature (Curing temperature)
Verified Date: 03/09/2026
Date Tested: 03/06/2026
Submitted By Organization: Con-Fab California Corporation - Shafter
Organization Address: 701 Golds Avenue,
Organization City: Shafter
Organization State: CA
Organization Zipcode: 93263
Organization Email: benjamina@confabca.com
Organization Phone: (661) 630-3283
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Precast Maximum Curing Temperature
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147 °F
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DIME Test ID: 2026-03-06-15-5
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 03/09/2026
Date Tested: 03/06/2026
Submitted By Organization: Con-Fab California Corporation - Shafter
Organization Address: 701 Golds Avenue,
Organization City: Shafter
Organization State: CA
Organization Zipcode: 93263
Organization Email: benjamina@confabca.com
Organization Phone: (661) 630-3283
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
