Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214579 DEA: 010B0904 EFIS: 0100020444
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-8.2/8.7
Work Description: Panther Creek & Hunter Creek Bridges
Location Description: DEL NORTE COUNTY NEAR KLAMATH AT PANTHER CREEK BRIDGE AND AT HUNTER CREEK BRIDGE
Contractor Name: Golden State Bridge, Inc
Contractor Address: 3701 Mallard Dr., Benicia, CA 94510
Resident Engineer: Ryan Dunne Structure Rep.: Brian Cinkutis
DIME Sample ID: 2024-01-15-8
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: Verification
Type of Material: Concrete
Sample Taken Date: 01/15/2024
Date that the sample was received by the laboratory/organization performing the testing: 01/16/2024
The quantity of what the sample constitutes: 5 cylinders
A brief description of the sample: 6000 PSI Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 01-0085
Structure name: Panther Creek
The fabricator/manufacturer/facility name: Tidewater Starry pit
The concrete mix design number: SC-1
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 58952
Concrete batch plant: Tidewater Contractor
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: SIDEWALK
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-01-15-8-1
Test Method: ASTM C39-17a: 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.
