Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994574 DEA: 050C7334 EFIS: 0518000116
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-10.5/13.4
Work Description: CONSTRUCT OVERCROSSING AND AUXILIARY LANE/ Replace Capitola Ave OC + RWs and SWs
Location Description: SANTA CRUZ COUNTY IN AND NEAR CITY OF CAPITOLA FROM STATE PARK DRIVE OVERCROSSING TO 0.2 MILE NORTH OF BAY AVENUE UNDERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 580 West Beach Street, Watsonville, CA 95076
Resident Engineer: Fernando Dos Santos Structure Rep.: Daniel Dait
DIME Sample ID: 2024-04-16-81
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/16/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/17/2024
The quantity of what the sample constitutes: Concrete
A brief description of the sample: Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Capitola Ave OC
The fabricator/manufacturer/facility name: Graniterock
The concrete mix design number: 087722
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 427139
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Chute
Where the material sample would have been placed if not sampled: Abutment 3 CIDH Piles
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-04-16-81-1
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 05/21/2025
Date Tested: 05/16/2024
Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Organization Address: 1529 Salinas Highway,
Organization City: Monterey
Organization State: CA
Organization Zipcode: 93940
Organization Email: wesley.rider@dot.ca.gov
Organization Phone: (831) 818-0254
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
DIME Test ID: 2024-04-16-81-2
Test Method: ASTM C1064-12: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 05/21/2025
Date Tested: 05/16/2024
Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Organization Address: 1529 Salinas Highway,
Organization City: Monterey
Organization State: CA
Organization Zipcode: 93940
Organization Email: wesley.rider@dot.ca.gov
Organization Phone: (831) 818-0254
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
