Sample Record for 2023-06-26-104
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993815 DEA: 081C0814 EFIS: 0816000086
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R60.7/R74.3
Work Description: I-10 PAVEMENT REHABILITATION (SEGMENT 1) PROJECT
Location Description: Coachella
Contractor Name: COFFMAN SPECIALTIES, INC
Contractor Address: 4375 JUTLAND DRIVE STE 260, SAN DIEGO CA 92117
Resident Engineer: Michael Sergah Structure Rep.: Al Alina
Sample Information
DIME Sample ID: 2023-06-26-104
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: 06/26/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/27/2023
The quantity of what the sample constitutes: 5.0
A brief description of the sample: 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
Material Information
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: 3599
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.:
Test Results
Test 1 of 2
DIME Test ID: 2023-06-26-104-3
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) 630-7162
This test has been superseded on 06/10/2024. The corrected test ID is: 2023-06-26-104-4
Reason: retested
Test 2 of 2
DIME Test ID: 2023-06-26-104-4
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.
