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Sample Record for 2020-08-25-25

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

Project Information

Project ID: 214492 DEA: 033F5404 EFIS: 0313000136 QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99,160-4.5/5.7,R44.5
Work Description: FURNISH PRECAST PRESTRESSED CONCRETE SLAB & PLACE STRUCTURAL CONCRETE.
Location Description: SACRAMENTO COUNTY NEAR GALT ON ROUTE 99 FROM NORTH OF MINGO ROAD TO SOUTH OF ARNO ROAD OVERCROSSING AND IN SACRAMENTO ON ROUTE 160 AT AMERICAN RIVER BRIDGE
Contractor Name: BROSAMER & WALL, INC.
Contractor Address: 5000 Marsh Drive, Suite 300, Conord, CA 94520
Resident Engineer: Mohssen Ghassemi Structure Rep.: Chris Quon

Sample Information

DIME Sample ID: 2020-08-25-25
TL Number from the TL Form:
Sample Submitted By Organization: Trinity Engineering Laboratories, Inc. - Fresno
Sample Organization Contact: 559-292-2188
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/25/2020
Date that the sample was received by the laboratory/organization performing the testing: 08/26/2020
The quantity of what the sample constitutes: 4 cylinders
A brief description of the sample: 1615759 PCC
From where was the sample collected: Job Site
Laboratory sample identification: 20-192 082520
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CEMEX Lodi

Material Information

The concrete mix design number: 1615759
The truck number from where the sample was collected: 0699136
The batch plant ticket number from where the sample was collected: 41171733
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Truck
Where the material sample would have been placed if not sampled: unknown
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 3

DIME Test ID: 2020-08-25-25-1
Test Method: ASTM C143-15a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Submitted By Organization: Trinity Engineering Laboratories, Inc. - Fresno
Organization Address: 2437 N. Sunnyside Ave.,
Organization City: Fresno
Organization State: CA
Organization Zipcode: 93727
Organization Email:
Organization Phone: 559-292-2188
Data has not been verified.

Test 2 of 3

DIME Test ID: 2020-08-25-25-2
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Submitted By Organization: Trinity Engineering Laboratories, Inc. - Fresno
Organization Address: 2437 N. Sunnyside Ave.,
Organization City: Fresno
Organization State: CA
Organization Zipcode: 93727
Organization Email:
Organization Phone: 559-292-2188
Data has not been verified.

Test 3 of 3

DIME Test ID: 2020-08-25-25-3
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 08/17/2021
Date Tested: 09/22/2020
Submitted By Organization: Trinity Engineering Laboratories, Inc. - Fresno
Organization Address: 2437 N. Sunnyside Ave.,
Organization City: Fresno
Organization State: CA
Organization Zipcode: 93727
Organization Email:
Organization Phone: 559-292-2188
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Number of specimens 2
Average Compressive Strength (to nearest 10) 5240 lb/in^2
Cylinder Age 28 days
Break Description of Cylinder 1 (if not 'cone') 1
Break Description of Cylinder 2 (if not 'cone') 2

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.