Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214601 DEA: 041J5694 EFIS: 0419000313
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101-0.0/21.8
Work Description: San Mateo US 101 Express Lanes North
Location Description:
Contractor Name: KIEWIT INFRASTRUCTURE COMPANY
Contractor Address: 1301 SHOREWAY RD, SUITE 275, BELMONT, CA 94402
Resident Engineer: Douglas Inori Structure Rep.: Tyler Pinell
DIME Sample ID: 2020-09-17-28
TL Number from the TL Form:
Sample Submitted By Organization: Pro-Cast Products, Incorporated - Highland
Sample Organization Contact: (909) 793-7602
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 09/17/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/18/2020
The quantity of what the sample constitutes: 53
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Procast
The concrete mix design number: RRM14062
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 15736049
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2020-09-17-28-1
Test Method: ASTM C39-18: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Submitted By Organization: Pro-Cast Products, Incorporated - Highland
Organization Address: 27417 East Third Street,
Organization City: Highland
Organization State: CA
Organization Zipcode: 92346
Organization Email: bmalott@procastproducts.com
Organization Phone: (909) 809-2429
Data has not been verified.
DIME Test ID: 2020-09-17-28-2
Test Method: ASTM C143-15a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Submitted By Organization: Pro-Cast Products, Incorporated - Highland
Organization Address: 27417 East Third Street,
Organization City: Highland
Organization State: CA
Organization Zipcode: 92346
Organization Email: bmalott@procastproducts.com
Organization Phone: (909) 809-2429
Data has not been verified.
