Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993868 DEA: 050C7324 EFIS: 0512000228
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-13.4/14.9
Work Description: CONSTRUCT PEDESTRIAN OVERCROSSING AND AUXILIARY LANE.
Location Description: SANTA CRUZ COUNTY IN AND NEAR CITY OF CAPITOLA FROM 0.2 MILE SOUTH OF 41ST AVENUE OVERCROSSING TO 0.2 MILE NORTH OF SOQUEL DRIVE OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 585 BEACH STREET, WATSONVILLE CA 95076
Resident Engineer: Gareth Gill Structure Rep.: Alejandro (Alex) Gomez
DIME Sample ID: 2023-06-13-76
TL Number from the TL Form: 252863
Sample Submitted By Organization: CT D05 - Santa Cruz Field Laboratory
Sample Organization Contact:
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 06/13/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/14/2023
The quantity of what the sample constitutes: 3 4x8 concrete cylinders
A brief description of the sample: Concrete for Bent # 2
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Las Animas Concrete
The concrete mix design number: 713W2S5
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant: Las Animas Santa Cruz
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Wheel Barrow from Chute
Where the material sample would have been placed if not sampled: Bent 2
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-06-13-76-1
Test Method: ASTM C39-17a: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Submitted By Organization: CT D05 - Santa Cruz Field Laboratory
Organization Address: 8115 Prunedale North Road,
Organization City: Salinas
Organization State: CA
Organization Zipcode: 93907
Organization Email: anthony.romiza@dot.ca.gov
Organization Phone: (805) 319-0941
Data has not been verified.
