Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994820 DEA: 060V1104 EFIS: 0616000208
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE,KIN-5,41,198-Var
Work Description: STRATFORD KINGS RIVER BRIDGE REPLACEMENT.
Location Description: FRESNO AND KINGS COUNTIES AT VARIOUS LOCATIONS
Contractor Name: M.C.M. Construction, INC. (Richard McCall)
Contractor Address: 6413 32nd Street, North Highlands, Ca 95660
Resident Engineer: Din Dadawalla Structure Rep.: Martin Garcia
DIME Sample ID: 2024-03-01-6
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California, LLC
Sample Organization Contact: (661) 630-7162
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 03/01/2024
Date that the sample was received by the laboratory/organization performing the testing: 03/05/2024
The quantity of what the sample constitutes: 27
A brief description of the sample: Type T-II/V Cement
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ConFab California, LLC Shafter
The concrete mix design number: SCC_S8.5-0FG
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 4484
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Sampled from wheelbarrow collected from chute of ready mix truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-03-01-6-1
Test Method: ASTM C1611-21: Standard Test Method for Slump Flow of Self-Consolidating Concrete
Submitted By Organization: Con-Fab California, LLC
Organization Address: 701 Golds Avenue,
Organization City: Shafter
Organization State: CA
Organization Zipcode: 93263
Organization Email: benjamina@confabca.com
Organization Phone: (661) 630-3283
Data has not been verified.
