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Sample Record for 2018-11-19-5

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

Project Information

Project ID: 213474 DEA: 010A8404 EFIS: 0113000058 QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-271-17.7/18.0
Work Description: BRIDGE REPLACEMENT, ROADWAY REALIGNMENT AND WIDENING.
Location Description: MENDOCINO COUNTY NEAR PIERCY FROM 0.7 MILE NORTH OF HIGHWAY 271/101 SEPARATION TO 0.4 MILE SOUTH OF THE SIDEHILL VIADUCT
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: PO Box 1006, Eureka, CA 95502
Resident Engineer: Joaquin Rodriguez Structure Rep.: Peter O'Donnell

Sample Information

DIME Sample ID: 2018-11-19-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 11/19/2018
Date that the sample was received by the laboratory/organization performing the testing: 11/20/2018
The quantity of what the sample constitutes: 2
A brief description of the sample: Concrete Cylinder 6 x 12
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: KieCon

Material Information

The concrete mix design number: k4560-452a
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: unk
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: fabricator
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
Test results on following page(s): 1

Test Results

Test 1 of 1

DIME Test ID: 2018-11-19-5-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C1231
Submitted By Organization: CT HQ - QASI Bay Area Field Office
Organization Address: 690 Walnut Avenue, Suite 150,
Organization City: Vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: maged.g.armanuse@dot.ca.gov
Organization Phone: (916) 284-6784
Data has not been verified.