Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993868 DEA: 050C7324 EFIS: 0512000228
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-13.4/14.9
Work Description: CONSTRUCT PEDESTRIAN OVERCROSSING AND AUXILIARY LANE.
Location Description: SANTA CRUZ COUNTY IN AND NEAR CITY OF CAPITOLA FROM 0.2 MILE SOUTH OF 41ST AVENUE OVERCROSSING TO 0.2 MILE NORTH OF SOQUEL DRIVE OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 585 BEACH STREET, WATSONVILLE CA 95076
Resident Engineer: Gareth Gill Structure Rep.: Alejandro (Alex) Gomez
DIME Sample ID: 2024-05-08-74
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3675 - Monterey, Santa Cruz, San Benito
Sample Organization Contact: (805) 471-2109
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/08/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/09/2024
The quantity of what the sample constitutes: 16 CY
A brief description of the sample: Type II/V Cement
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: RW "N" Curb and Pilaster
The fabricator/manufacturer/facility name: Las Animas Concrete
The concrete mix design number: C2S30
The truck number from where the sample was collected: 123
The batch plant ticket number from where the sample was collected: 381110
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Discharge from concrete truck into wheelbarrow
Where the material sample would have been placed if not sampled: curb and pilaster
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-05-08-74-1
Test Method: CTM 556-January 2018: Method of Test for Slump of Fresh Portland Cement Concrete
Submitted By Organization: CT SC - 3675 - Monterey, Santa Cruz, San Benito
Organization Address: 4485 Vachell Lane,
Organization City: San Luis Obispo
Organization State: CA
Organization Zipcode: 93401
Organization Email: neil.weller@dot.ca.gov
Organization Phone: (805) 471-2109
Data has not been verified.
