Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208945 DEA: 07288604 EFIS: 0700021080 COOP: 074663
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-710-6.0-9.4
Work Description: Gerald Desmond Bridge Replacement - A Design Build project. IQA samples will be selected by Port/Caltrans representatives and sent to Translab for testing.
Location Description: Port of Long Beach (District 7)
Contractor Name: Shimmick/FCC/Impregilo (SFI) JV
Contractor Address: 11 Golden Shore, Suite 330, Long Beach, CA 90802
Resident Engineer: Structure Rep.: Sami Deeb
DIME Sample ID: 2019-09-11-21
TL Number from the TL Form: 911B
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/11/2019
Date that the sample was received by the laboratory/organization performing the testing: 09/13/2019
The quantity of what the sample constitutes: 3
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 866-911B
Structure unique identifier:
Structure name: tower 16 segments WC06 and WS06 stitch pour
The fabricator/manufacturer/facility name: sfi joint venture
The concrete mix design number: sfi l wsbs5a
The truck number from where the sample was collected: 596
The batch plant ticket number from where the sample was collected: 441847
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: SFI
A detailed description of where the material sample was collected: 70 cy
Where the material sample would have been placed if not sampled: tower 16 segments WC06 and WS06 stitch pour
From Lot No.: Unknown
Bag Lot No.: Unknown
DIME Test ID: 2019-09-11-21-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C617/CTM521 Cured in accordance with ASTM C511
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
Data has not been verified.