Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214422 DEA: 040J6424 EFIS: 0414000476
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-101-32.8/R54.2
Work Description: CRACK, SEAT AND OVERLAY WITH RHMA AND HMA, AND REPLACE CULVERTS.
Location Description: SONOMA COUNTY AT VARIOUS LOCATIONS FROM LIMERICK LANE OVERCROSSING TO ROUTE 101/128 SEPARATION
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: 1520 FOURTH STREET, BERKELY, CA 94710
Resident Engineer: Syd Valeh Structure Rep.: Jonathan Chi
DIME Sample ID: 2021-06-22-19
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 06/22/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/25/2021
The quantity of what the sample constitutes: 2.8 CY
A brief description of the sample: SCC concrete
From where was the sample collected: Manufacturer
Laboratory sample identification: 21135
Structure unique identifier: 04-son-101-32.8/R54.2
Structure name: State Hwy in Sonoma County 101/128 Separation
The fabricator/manufacturer/facility name: Oldcastle Infrastructure
The concrete mix design number: 55
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 92860
Concrete batch plant: Oldcastle Infrastructure
The fabricator/manufacturer designation for the sample: Mix No. 55
A detailed description of where the material sample was collected: Travelling Bucket
Where the material sample would have been placed if not sampled: RBC
From Lot No.:
Bag Lot No.:
DIME Test ID: 2021-06-22-19-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 06/25/2021
Date Tested: 06/25/2021
Submitted By Organization: CT HQ - QASI Sacramento Field Office
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: seyedhamed.sadati@dot.ca.gov
Organization Phone: (916) 205-8871
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
