Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215486 DEA: 040A0204 EFIS: 0400000129
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-1-15-15.7
Work Description: Construct roadway and bridge with structural concrete and CIDH piling
Location Description: District-County-Route-Post Mile: 04-Son-1-R15.0/R15.7
Contractor Name: BRIDGEWAY CIVIL CONSTRUCTORS, INC.
Contractor Address: 4950 Allison Parkway, # A, Vacaville, CA 95688
Resident Engineer: Fabio La Serna Structure Rep.: Bunma Nou
DIME Sample ID: 2022-10-10-30
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: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 10/10/2022
Date that the sample was received by the laboratory/organization performing the testing: 10/12/2022
The quantity of what the sample constitutes: 12 concrete cylinders
A brief description of the sample: 12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: River Ready Mix
The concrete mix design number: 76425003
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 76425003
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: North side spandrel
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-10-10-30-1
Test Method: ASTM C39-18: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
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.
DIME Test ID: 2022-10-10-30-2
Test Method: ASTM C39-18: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
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.
