Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995260 DEA: 061G0504 EFIS: 0623000195
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-VAR,(180),245-99/104, (99.0)/0.0/(104.0)/9.0
Work Description: Routes 180, 245 Emergency Slip Out Repair
Location Description:
Contractor Name: CAL VALLEY CONSTRUCTION
Contractor Address: 5125 N. Gates Ave, Ste 102, Fresno, CA 93722
Resident Engineer: Mark Mengoni Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2024-04-23-42
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Fresno Construction Field Office
Sample Organization Contact: (559) 243-3828
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/25/2024
The quantity of what the sample constitutes: 12
A brief description of the sample: Pile 10&12
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: 245 EMERGENCY WALL 2
The fabricator/manufacturer/facility name: Outback
The concrete mix design number: 40F5G07
The truck number from where the sample was collected: 110
The batch plant ticket number from where the sample was collected: 158308
Concrete batch plant: Outback Materials
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: wheelbarrow
Where the material sample would have been placed if not sampled: Pile 10&12
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-04-23-42-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: CT D06 - Millbrook Field Laboratory
Organization Address: 3240 North Millbrook Avenue,
Organization City: Fresno
Organization State: CA
Organization Zipcode: 93726
Organization Email: tomas.silva@dot.ca.gov
Organization Phone: (559) 417-5341
Data has not been verified.
