Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212720 DEA: 07291404 EFIS: 0712000094
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1-55-58
Work Description: TRANCAS CREEK BRIDGE REPLACEMENT
Location Description: IN LOS ANGELES IN CITY OF MALIBU AT TRANCAS CREEK BRIDGE (53-0027).
Contractor Name: STACY AND WITBECK, INC.
Contractor Address: 3939 Atlantic Ave Suite 114, Long Beach, CA 90807
Resident Engineer: Dan Leon Structure Rep.: Frank Lofti
DIME Sample ID: 2022-07-29-46
TL Number from the TL Form:
Sample Submitted By Organization: Bethlehem Construction, Incorporated
Sample Organization Contact: (661) 758-1001
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 07/29/2022
Date that the sample was received by the laboratory/organization performing the testing: 07/29/2022
The quantity of what the sample constitutes: 24 CY
A brief description of the sample: Voided Slab
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bethlehem Construction
The concrete mix design number: SCC-ASH-32_3
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 0009628
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: MIDDLE OF THE LOAD
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-07-29-46-1
Test Method: ASTM C39-21: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Verified Date: 08/30/2022
Date Tested: 07/29/2022
Submitted By Organization: Bethlehem Construction, Incorporated
Organization Address: 425 J Street,
Organization City: Wasco
Organization State: CA
Organization Zipcode: 93280
Organization Email: keithl@bethlehemconstruction.com
Organization Phone: (661) 758-1001
General Comments for this Test:
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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2
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Test performed
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With density determined by dimension measurements
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Average cylinder density (to nearest 1 pcf)
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6 lb/ft^3
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Average diameter of cylinder 1
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6.00 in
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Average diameter of cylinder 2
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6.00 in
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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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Serial number of delivery ticket, if available
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no data
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