Sample Record for 2022-09-12-20

Project ID: 215677 DEA: 044G0804 EFIS: 0412000332 COOP: 042676 QA Service Level: 1

DIST-CO-RTE-PM: 04-SOL-80-R10.4/30.2

Work Description: Highway widening, overhead signs, and electronic toll system.

Location Description: In Solano County in Fairfield and Vacaville from 1.0 mile west of Red Top Road Undercrossing to 0.4 mile east of Leisure Town Road Overcrossing.

Contractor Name: O.C. JONES & SONS, INC.

Contractor Address: 1520 Fourth Street, Berkeley, CA 94710

Resident Engineer: Justen Tatum Structure Rep.: Kelsey Littell

DIME Sample ID: 2022-09-12-20

TL Number from the TL Form:

Sample Submitted By Organization: CT D04 - Fairfield Construction Field Office 59-545

Sample Organization Contact: 510-714-7055

Type of Sample: Quality Assurance

Type of Material: Concrete

Sample Taken Date: 09/12/2022

Date that the sample was received by the laboratory/organization performing the testing: 09/14/2022

The quantity of what the sample constitutes: 3 cylinders

A brief description of the sample: 4x8 concrete cylinders

From where was the sample collected: Job Site

Laboratory sample identification:

Structure unique identifier:

Structure name: Retaining Wall 5

The fabricator/manufacturer/facility name: Cemex Fairfield

The concrete mix design number: 1615759

The batch plant ticket number from where the sample was collected: 42161674

Concrete batch plant: Cemex Fairfield

A detailed description of where the material sample was collected: Truck

Where the material sample would have been placed if not sampled: jobsite