Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210837 DEA: 080J0804 EFIS: 0800000283 COOP: 081625
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15-34.7/51.6
Work Description: (Alternative Delivery) DESIGN-BUILD OF THE INTERSTATE 15 EXPRESS LANES PROJECT
Location Description: Riverside County and SBD-15-0.0/1.3
Contractor Name: Skanska-Ames, Joint Venture
Contractor Address: 1801 California Avenue, Corona, CA 92881
Resident Engineer: Roy Fisher (reports) Structure Rep.: Roy Fisher
DIME Sample ID: 2019-10-28-29
TL Number from the TL Form: 123
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: 10/28/2019
Date that the sample was received by the laboratory/organization performing the testing: 10/30/2019
The quantity of what the sample constitutes: 4
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 974-123
Structure unique identifier:
Structure name: Light pole sta 2367 95 type A spread footing
The fabricator/manufacturer/facility name: ROBERTSONS CORONA
The concrete mix design number: SM446B38
The truck number from where the sample was collected: 1028
The batch plant ticket number from where the sample was collected: 5010479
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: SKANSKA AMES
A detailed description of where the material sample was collected: 10 cy
Where the material sample would have been placed if not sampled: Light pole sta 2367 95 type A spread footing
From Lot No.: Unknown
Bag Lot No.: Unknown
DIME Test ID: 2019-10-28-29-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C617/CTM521
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: 9098293029
Data has not been verified.
