Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88887 DEA: PC-Barrier-STOCK EFIS: PC-Barrier-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for precast barrier rail stock material.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-09-14-56
TL Number from the TL Form:
Sample Submitted By Organization: Jensen Precast - Lockeford
Sample Organization Contact: (916) 992-8309
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 09/14/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/14/2022
The quantity of what the sample constitutes: 18.16 yards
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Source
Laboratory sample identification: 100006010-4
Structure unique identifier: 04-200050664
Structure name: JJ-Hooks Barrier
The fabricator/manufacturer/facility name: Jensen Precast
The concrete mix design number: 100006010
The truck number from where the sample was collected: stationary mixer
The batch plant ticket number from where the sample was collected: 2022091510004
Concrete batch plant: Jensen Precast
The fabricator/manufacturer designation for the sample: zone 1
A detailed description of where the material sample was collected: zone 1
Where the material sample would have been placed if not sampled: zone 1
From Lot No.: 12404
Bag Lot No.: 12404
DIME Test ID: 2022-09-14-56-1
Test Method: ASTM C1064-12: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 09/21/2022
Date Tested: 09/14/2022
Submitted By Organization: Jensen Precast - Lockeford
Organization Address: 12101 E. Brandt Road,
Organization City: Lockeford
Organization State: CA
Organization Zipcode: 95237
Organization Email: avery.flores@jensenprecast.com
Organization Phone: (916) 992-8309
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
