Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994327 DEA: 081G4704 EFIS: 0816000001
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-3.1/53.5
Work Description: STRUCTURAL CONC BR, CONC SLAB, HMA (TYPE A), ALT CRASH CUSHION SYSTEM.
Location Description: RIVERSIDE COUNTY NEAR LAKE ELSINORE AT MORRILL CANYON BRIDGE AND NEAR HEMET AT STRAWBERRY CREEK BRIDGE.
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 26320 LESTER CIRCLE;, CORONA CA 92883
Resident Engineer: Mike A Bergevin Structure Rep.: Arnel Vega
DIME Sample ID: 2024-01-26-58
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: 01/26/2024
Date that the sample was received by the laboratory/organization performing the testing: 01/26/2024
The quantity of what the sample constitutes: 20 CY
A brief description of the sample: QC Sampling Data
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kie-Con Antioch
The concrete mix design number: K5070-0001
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 120553
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-01-26-58-1
Test Method: ASTM C231-10: Standard Test Method for Air Content of Freshly Mixed Concrete by the Pressure Method
Verified Date: 04/12/2024
Date Tested: 01/26/2024
Submitted By Organization: Kie-Con, Incorporated - Antioch
Organization Address: 3551 Wilbur Avenue,
Organization City: Antioch
Organization State: CA
Organization Zipcode: 94509
Organization Email: gregory.lask@kiewit.com
Organization Phone: (925) 331-7122
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
