Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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: 2023-07-08-2
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: 07/08/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/06/2023
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: Ulatis CIDH Bent 5 Pile 1 and Abt 6 Pile 1
The fabricator/manufacturer/facility name: Unknown
The concrete mix design number: CT072CR8D
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 380842
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: back of truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-07-08-2-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 07/03/2024
Date Tested: 07/08/2023
Submitted By Organization: CT D04 - Fairfield Construction Field Office 59-545
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: alejandro.lara@dot.ca.gov
Organization Phone: (510) 714-7055
General Comments for this Test: Performed by RMA
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2023-07-08-2-3
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 07/03/2024
Date Tested: 07/08/2023
Submitted By Organization: CT D04 - Fairfield Construction Field Office 59-545
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: alejandro.lara@dot.ca.gov
Organization Phone: (510) 714-7055
General Comments for this Test: Performed by RMA
Test Result Compliance:
Additional Comments When Verified:
