Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994309 DEA: 033H5404 EFIS: 0318000012
QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-70-46.0/47.0
Work Description: RAISE ALIGNMENT, PLACE HMA, STRUCTURAL CONCRETE & BRIDGE RAIL.
Location Description: BUTTE COUNTY NEAR PARADISE FROM 0.8 MILE WEST OF SHADY REST AREA TO 0.2 MILE EAST OF SHADY REST AREA
Contractor Name: VIKING CONSTRUCTION COMPANY, INC.
Contractor Address: 11315 SUNRISE GOLD CIR. #A, RANCHO CORDOVA CA 95742
Resident Engineer: Daniel Rechs Structure Rep.: Adam Scardaci
DIME Sample ID: 2023-08-22-85
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: 08/22/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/22/2023
The quantity of what the sample constitutes: 8.5 CY
A brief description of the sample: QC Sampling Data
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kie-Con
The concrete mix design number: K4060-14212
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 119271
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheel barrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-08-22-85-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 08/23/2024
Date Tested: 08/22/2023
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:
Test Result Compliance:
Additional Comments When Verified:
