Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215620 DEA: 01436404 EFIS: 0100000193
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-35.8/36.5
Work Description: Dr. Fine Bridge Replacement
Location Description: DR. FINE BRIDGE REPLACEMENT FROM LAKE EARL DR TO S FRED D. HAIGHT DR ON HWY 101 ACROSS SMITH RIVER.
Contractor Name: MCM Construction
Contractor Address: PO Box 620, North Highlands, Ca 95660
Resident Engineer: Clayton Malmberg Structure Rep.: Brian Cinkutis
DIME Sample ID: 2023-12-21-4
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: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 12/21/2023
Date that the sample was received by the laboratory/organization performing the testing: 12/22/2023
The quantity of what the sample constitutes: 50cy
A brief description of the sample: Concrete Test Samples
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 01-0041 temporary bridge
Structure name: Dr. Fine
The fabricator/manufacturer/facility name: Tidewater Starry pit
The concrete mix design number: SR-Min ST NA
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 58917
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
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: K-rail base north end
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-12-21-4-1
Test Method: ASTM C39-21: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
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.
