Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994522 DEA: 010F7604 EFIS: 0116000060
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-199-28.1/28.1
Work Description: Rehab Idlewild Maint Station
Location Description:
Contractor Name: Broward Builders, Inc.
Contractor Address: 1200 E Kentucky Ave, Woodland, CA 95776
Resident Engineer: Aaron Valley Structure Rep.: Joshua Erler
DIME Sample ID: 2023-10-05-21
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Crescent City Field Laboratory
Sample Organization Contact: (707) 496-5581
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 10/05/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/06/2023
The quantity of what the sample constitutes: 230 CY
A brief description of the sample: 5 12"x6" concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 01-0F7604
Structure name: Idlewild Builings
The fabricator/manufacturer/facility name: Freeman Rock and Sand
The concrete mix design number: 278CTSAP
The truck number from where the sample was collected: 44
The batch plant ticket number from where the sample was collected: 70917
Concrete batch plant: 155569
The fabricator/manufacturer designation for the sample: Freeman Rock
A detailed description of where the material sample was collected: Back of truck chute
Where the material sample would have been placed if not sampled: stem walls and footings
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-10-05-21-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C1231 - Unbonded Elastomeric Pad Cap Cured in accordance with ASTM C511
Submitted By Organization: CT D01 - Crescent City Field Laboratory
Organization Address: 1444 Parkway Dr.,
Organization City: Crescent City
Organization State: CA
Organization Zipcode: 95531
Organization Email: clayton.malmberg@dot.ca.gov
Organization Phone: (707) 496-5581
Data has not been verified.
