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Sample Record for 2013-10-24-1449

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

Project Information

Project ID: 7463 DEA: 042640U4 EFIS: 0412000195 QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-101-0.9/3.6
Work Description: CONSTRUCT PETALUMA BLVD SOUTH INTERCHANGE, REPLACE PETALUMA RIVER BR
Location Description: SONOMA COUNTY IN AND NEAR PETALUMA FROM GUNN DRIVE TO ROUTE 101/116 SEPARATION AND OVERHEAD
Contractor Name: GHILOTTI - CC MYERS JV
Contractor Address: 3286 Fitzgerald Road, Rancho Cordova, CA 95742
Resident Engineer: Richard Duncan Structure Rep.: Brian Beaudoin

Sample Information

DIME Sample ID: 2013-10-24-1449
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: Verification
Type of Material: Concrete
Sample Taken Date: 10/24/2013
Date that the sample was received by the laboratory/organization performing the testing: 10/30/2013
The quantity of what the sample constitutes: 2 concrete cylinders
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ConFab

Material Information

The concrete mix design number: V915-25F
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: Unknown
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: By formwork at precast plant
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 1

DIME Test ID: 2013-10-24-1449-1
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 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.