Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993169 DEA: 050A0904 EFIS: 0513000028
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-156-R1.4/R2.0
Work Description: WIDEN REINFORCED STRUCTURAL CONCRETE BRIDGE & REPLACE BRIDGE RAILING.
Location Description: MONTEREY COUNTY IN AND NEAR CASTROVILLE FROM 0.3 MILE EAST OF ROUTE 156/183 SEPARATION TO 0.2 MILE EAST OF CASTROVILLE BOULEVARD
Contractor Name: Granite Rock (Bryan Jones)
Contractor Address: 5225 Hellyer Ave, Ste 220, San Jose, CA 95138
Resident Engineer: David Hopper Structure Rep.: Dean Russu
DIME Sample ID: 2022-08-19-79
TL Number from the TL Form:
Sample Submitted By Organization: Kie-Con, Incorporated - Antioch
Sample Organization Contact: (925) 331-7122
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/19/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/19/2022
The quantity of what the sample constitutes: 19.25CY
A brief description of the sample: QC concrete sampling
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name: Castroville
The fabricator/manufacturer/facility name: Kie-Con Antioch
The concrete mix design number: K4050900S
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 115582
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Dischard fron concrete truck into wheelbarrow.
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-08-19-79-1
Test Method: CTM 556-January 2018: Method of Test for Slump of Fresh Portland Cement Concrete
Verified Date: 08/03/2023
Date Tested: 08/19/2022
Submitted By Organization: Kie-Con, Incorporated - Antioch
Organization Address: 3551 Wilbur Avenue,
Organization City: Antioch
Organization State: CA
Organization Zipcode: 94509
Organization Email: cesar.rodriguez3@kiewit.com
Organization Phone: (925) 302-3654
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2022-08-19-79-2
Test Method: CTM 518-June 2010: Method of Test for Unit Weight of Fresh Concrete
Submitted By Organization: Kie-Con, Incorporated - Antioch
Organization Address: 3551 Wilbur Avenue,
Organization City: Antioch
Organization State: CA
Organization Zipcode: 94509
Organization Email: cesar.rodriguez3@kiewit.com
Organization Phone: (925) 302-3654
Data has not been verified.
