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Sample Record for 2024-10-04-12

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 1000259 DEA: 050N74V4 EFIS: 0522000043 QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-9.2/9.7
Work Description:
Location Description: FOR CONSTRUCTION ON STATE HIGHWAY IN SANTA BARBARA COUNTY AT MONTECITO FROM 0.2 MILE NORTH OF SHEFFIELD DRIVE UNDERCROSSING TO 0.3 MILE SOUTH OF SAN YSIDRO ROAD OVERCROSSING
Contractor Name: Granite Construction Company
Contractor Address: P.O. Box 6744, Santa Barbara, CA 93160
Resident Engineer: Taylor Merlo Structure Rep.: Emiliano Berntsen

Sample Information

DIME Sample ID: 2024-10-04-12
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Sample Organization Contact: (805) 621-3616
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 10/04/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/04/2024
The quantity of what the sample constitutes: 70 cy
A brief description of the sample: Concrete Test Samples
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CEMEX Santa Barbara

Material Information

The concrete mix design number: 1629003
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 31368377
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:
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 2

DIME Test ID: 2024-10-04-12-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 10/07/2024
Date Tested: 10/04/2024
Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Organization Address: 21 Griffin Road North,
Organization City: Windsor
Organization State: CT
Organization Zipcode: 06095-1590
Organization Email: dlachaine@trccompanies.com
Organization Phone: (805) 621-3616
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Temperature 79 F

Test 2 of 2

DIME Test ID: 2024-10-04-12-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 10/07/2024
Date Tested: 10/04/2024
Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Organization Address: 21 Griffin Road North,
Organization City: Windsor
Organization State: CT
Organization Zipcode: 06095-1590
Organization Email: dlachaine@trccompanies.com
Organization Phone: (805) 621-3616
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Slump 6 inch