Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993333 DEA: 04264724 EFIS: 0419000068
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-R20.8/27.1
Work Description: CIP BRIDGES, CONSTRUCT ROADWAY, RETAINING WALLS AND MODIFY ELECTRICAL.
Location Description: MARIN COUNTY IN AND NEAR NOVATO FROM 0.1 MILE SOUTH OF FRANKLIN AVENUE OVERHEAD TO 0.5 MILE SOUTH OF SAN ANTONIO CREEK BRIDGE
Contractor Name: GHILOTTI CONSTRUCTION CO. INC. (RILEY GENAZZI & JOSH SERAFINO)
Contractor Address: 246 GHILOTTI AVE., SANTA ROSA, CA 95407
Resident Engineer: Fabio La Serna Structure Rep.: Jeremy Light
DIME Sample ID: 2024-09-23-27
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3672 - Novato Field Office
Sample Organization Contact: (916) 621-8033
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/23/2024
The quantity of what the sample constitutes: 18CY
A brief description of the sample: 3 4x8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: DS40 WW & DS76 Bulkhead
The fabricator/manufacturer/facility name: Shamrock Materials Inc
The concrete mix design number: SL4201CG
The truck number from where the sample was collected: 2427
The batch plant ticket number from where the sample was collected: 293631
Concrete batch plant: 138
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: CHUTE FROM TRUCK
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-09-23-27-1
Test Method: ASTM C1064-08: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 09/24/2024
Date Tested: 09/23/2024
Submitted By Organization: CT SC - 3672 - Novato Field Office
Organization Address: 384 Bel Marin Keys Boulevard, Suite 200,
Organization City: Novato
Organization State: CA
Organization Zipcode: 94949
Organization Email: josh.velono@dot.ca.gov
Organization Phone: (916) 621-8033
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
DIME Test ID: 2024-09-23-27-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 09/24/2024
Date Tested: 09/23/2024
Submitted By Organization: CT SC - 3672 - Novato Field Office
Organization Address: 384 Bel Marin Keys Boulevard, Suite 200,
Organization City: Novato
Organization State: CA
Organization Zipcode: 94949
Organization Email: josh.velono@dot.ca.gov
Organization Phone: (916) 621-8033
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
