Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208572 DEA: 100L3304 EFIS: 1000000100 COOP: 10355 Permit Numbers: 1012NMC0508
QA Service Level: 1
DIST-CO-RTE-PM: 10-STA-99-0.0/0.3
Work Description: Reconsteuct SR99/Kiernan Interchange
Location Description: City of Salida, in STA County
Contractor Name: O.C. Jones & Sons, Inc.
Contractor Address: 1520 Fourth Street, Berkeley, CA 94710
Resident Engineer: Steve Sakata Structure Rep.: Kelvin Low
DIME Sample ID: 2014-02-10-12002976
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Informational
Type of Material: Concrete
Sample Taken Date: 02/10/2014
Date that the sample was received by the laboratory/organization performing the testing: 02/12/2014
The quantity of what the sample constitutes: 2 concrete cylinders
A brief description of the sample: Mix Design K6090-621SCC
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name: PCPS Wide Flange Girder No. G-3
The fabricator/manufacturer/facility name: KieCon
The concrete mix design number: K6090-621SCC
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 11111
Concrete batch plant:
The fabricator/manufacturer designation for the sample: KieCon
A detailed description of where the material sample was collected: By formwork at precast plant during pour inspection (Third Truck Load)
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2014-02-10-12002976-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C617/CTM521 Cured in accordance with ASTM C511
Submitted By Organization: CT HQ - QASI Bay Area Field Office
Organization Address: 690 Walnut Avenue, Suite 150,
Organization City: Vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: maged.g.armanuse@dot.ca.gov
Organization Phone: (916) 284-6784
Data has not been verified.
