Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 9999 DEA: 00000000 EFIS: 0000000000 COOP: 99999333399 MINOR: 333333 Permit Numbers: 555555 0400NRT0000
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: YYZ
Contractor Address: 1234 address, Sacramento, CA 95824
Resident Engineer: RE_first RE_last Structure Rep.: SR_First SR_Last
DIME Sample ID: 2021-07-20-1
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: 07/20/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/20/2021
The quantity of what the sample constitutes: 50 CY
A brief description of the sample: concrete, aggregate
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Test
The concrete mix design number: Mix Design Test
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: Batch Ticket Number
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: back of truck, stockpile
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2021-07-20-1-1
Test Method: ASTM C138-17a: Standard Test Method for Density (Unit Weight), Yield, and Air Content (Gravimetric) of Concrete
Verified Date: 07/20/2021
Date Tested: 07/20/2021
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:
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Identification of concrete represented by the sample
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Batch Number
|
|
Volume of the measure
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1.25 ft^3
|
|
Density of concrete
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2.4 lb/ft^3
|
|
Yield of concrete
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no data
|
|
Relative yield of the batch
|
no data
|
|
Cement content
|
no data
|
|
Air content
|
no data
|
DIME Test ID: 2021-07-20-1-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
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
Data has not been verified.
DIME Test ID: 2021-07-20-1-3
Test Method: ASTM C39-21: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
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
Data has not been verified.
