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: 2024-08-01-94
TL Number from the TL Form:
Sample Submitted By Organization: Construction Testing Services
Sample Organization Contact: (925) 351-6905
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/01/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/02/2024
The quantity of what the sample constitutes: 3 cores
A brief description of the sample: Shotcrete Cores
From where was the sample collected: Job Site
Laboratory sample identification: 277343
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Graniterock
The concrete mix design number: 08S855
The truck number from where the sample was collected: 2415
The batch plant ticket number from where the sample was collected: 428989
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Shotcrete Retaining Wall
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-08-01-94-1
Test Method: ASTM C1064-12: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Submitted By Organization: Construction Testing Services
Organization Address: 2118 Rheem Drive,
Organization City: Pleasanton
Organization State: CA
Organization Zipcode: 94588
Organization Email: rring@cts-1.com
Organization Phone: (925) 351-6905
Data has not been verified.
DIME Test ID: 2024-08-01-94-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 08/12/2024
Date Tested: 08/01/2024
Submitted By Organization: Construction Testing Services
Organization Address: 2118 Rheem Drive,
Organization City: Pleasanton
Organization State: CA
Organization Zipcode: 94588
Organization Email: rring@cts-1.com
Organization Phone: (925) 351-6905
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
