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Sample Record for 2021-10-04-36

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

Project Information

Project ID: 214321 DEA: 012982U4 EFIS: 0118000125 QA Service Level: 1
DIST-CO-RTE-PM: 01-LAK-29,175-28.5/31.6,8.2/8.5
Work Description: CONSTRUCT 4 LANE EXPRESSWAY WITH EARTHWORK AND PAVING.
Location Description: LAKE COUNTY NEAR KELSEYVILLE ON ROUTE 29 FROM 0.6 MILE TO 3.7 MILES NORTH OF ROUTE 281 AND ON ROUTE 175 FROM SOUTH JUNCTION ROUTE 29 TO 0.3 MILE EAST OF SOUTH JUNCTION ROUTE 29
Contractor Name: FBD VANGUARD CONSTRUCTION, INC.
Contractor Address: 550 Greenville Rd, Livermore, CA 94550
Resident Engineer: Dan Kraft Structure Rep.: Tatjana Halda

Sample Information

DIME Sample ID: 2021-10-04-36
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: 10/04/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/04/2021
The quantity of what the sample constitutes: 100 cy
A brief description of the sample: Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Point Lakeview Rock and Redi-Mix

Material Information

The concrete mix design number: 3670538FS
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 23101
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Middle section of wall near the bottom of pour 5
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 4

DIME Test ID: 2021-10-04-36-1
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 4

DIME Test ID: 2021-10-04-36-2
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Submitted By Organization: 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 3 of 4

DIME Test ID: 2021-10-04-36-3
Test Method: CTM 518-June 2010: Method of Test for Unit Weight of Fresh 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 4 of 4

DIME Test ID: 2021-10-04-36-4
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.