Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 7826 DEA: 040A1854 EFIS: 0400020652 COOP: 042363
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-101-7.1/8.1
Work Description: RECONSTRUCT INTERCHANGE
Location Description: SONOMA COUNTY IN PETALUMA FROM 0.6 MILE SOUTH TO 0.4 MILE NORTH OF OLD REDWOOD HIGHWAY OVERCROSSING
Contractor Name: GHILOTTI CONSTRUCTION COMPANY
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Hal Streater Structure Rep.: Jonathan Chi
DIME Sample ID: 2013-11-19-8307297
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: 11/19/2013
Date that the sample was received by the laboratory/organization performing the testing: 11/20/2013
The quantity of what the sample constitutes: 2 concrete cylinders
A brief description of the sample: SCC
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name: Girder G-2 no. 6
The fabricator/manufacturer/facility name: KieCon
The concrete mix design number: K6090-621SCC
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 52071and52075
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.:
DIME Test ID: 2013-11-19-8307297-1
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.
