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Sample Record for 2021-06-05-6

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

Project Information

Project ID: 213653 DEA: 044G8204 EFIS: 0413000049 QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-10.6/10.8
Work Description: REPLACE SAN RAFAEL HARBOR BRIDGE (ABC)
Location Description: MARIN COUTY, IN SAN RAFAEL, FROM ROUTE 101 NORTHBOUND OFF-RAMP TO 2ND STREET
Contractor Name: Gordon N. Ball
Contractor Address: 333 Camille Ave., Alamo, CA 94507
Resident Engineer: Dawit Habteselassie Structure Rep.: Long N Ly

Sample Information

DIME Sample ID: 2021-06-05-6
TL Number from the TL Form:
Sample Submitted By Organization: RMA Group - Rancho Cordova
Sample Organization Contact: 916-631-7194
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 06/05/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/05/2021
The quantity of what the sample constitutes: 100 CY
A brief description of the sample: Portland Cement Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Shamrock

Material Information

The concrete mix design number: SL-3172
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 195337
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: ABUTMENT 1 EAST TO RIGHT
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 2

DIME Test ID: 2021-06-05-6-1
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Submitted By Organization: RMA Group - Rancho Cordova
Organization Address: 3150 Fitzgerald Road,
Organization City: Rancho Cordova
Organization State: CA
Organization Zipcode: 95742
Organization Email: mlowrance@rmacompanies.com
Organization Phone: 916-631-7194
Data has not been verified.

Test 2 of 2

DIME Test ID: 2021-06-05-6-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Submitted By Organization: RMA Group - Rancho Cordova
Organization Address: 3150 Fitzgerald Road,
Organization City: Rancho Cordova
Organization State: CA
Organization Zipcode: 95742
Organization Email: mlowrance@rmacompanies.com
Organization Phone: 916-631-7194
Data has not been verified.

Tests Assigned to this Sample

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