Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 7531 DEA: 042908C4 EFIS: 0400021248 COOP: 042397A3
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-580-R8.4/R14.6
Work Description: ROADWAY WIDENING AND REHABILITATION.
Location Description: ALAMEDA COUNTY IN LIVERMORE FROM 0.1 MILE WEST OF GREENVILLE ROAD UNDERCROSSING TO 0.5 MILE WEST OF 84/580 SEPARATION
Contractor Name: GHILOTTI CONSTRUCTION COMPANY
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Eddie Dike Structure Rep.: Kharakbir Sandhu
DIME Sample ID: 2013-12-12-7196
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: Informational
Type of Material: Concrete
Sample Taken Date: 12/12/2013
Date that the sample was received by the laboratory/organization performing the testing: 12/13/2013
The quantity of what the sample constitutes: 6x12 Cylinders
A brief description of the sample: PCP
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ConFab
The concrete mix design number: V80-25F
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 during pour inspection
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2013-12-12-7196-1
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.
