Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993141 DEA: 060V1204 EFIS: 0616000207
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD-99-R6.9/R7.6
Work Description: Cottonwood Creek Bridge Replacement - REPLACE BRIDGES AND CONSTRUCT RETAINING WALLS.
Location Description: MADERA COUNTY NEAR MADERA FROM 0.4 MILE SOUTH OF COTTONWOOD CREEK BRIDGE TO 0.1 MILE NORTH OF AVENUE 12 OVERCROSSING
Contractor Name: Security Paving Company, Inc.
Contractor Address: 3075 Townsgate Road, Westlake Village CA 91361
Resident Engineer: Din Dadawalla Structure Rep.: Ye Yang
DIME Sample ID: 2023-03-15-38
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: 03/15/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/15/2023
The quantity of what the sample constitutes: 32 CY
A brief description of the sample: Precast WFG
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: K7089900SLS
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 117212
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete sample from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-03-15-38-1
Test Method: ASTM C138-17a: Standard Test Method for Density (Unit Weight), Yield, and Air Content (Gravimetric) of Concrete
Verified Date: 07/09/2024
Date Tested: 03/15/2023
Submitted By Organization: Kie-Con, Incorporated - Antioch
Organization Address: 3551 Wilbur Avenue,
Organization City: Antioch
Organization State: CA
Organization Zipcode: 94509
Organization Email: cesar.rodriguez3@kiewit.com
Organization Phone: (925) 302-3654
General Comments for this Test: Unit weight = 151.6 lbs/cf
Test Result Compliance:
Additional Comments When Verified:
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Identification of concrete represented by the sample
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117212
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Volume of the measure
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0.25 ft^3
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Density of concrete
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151.6 lb/ft^3
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Yield of concrete
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no data
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Relative yield of the batch
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no data
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Cement content
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no data
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Air content
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no data
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