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Sample Record for 2021-10-20-41

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

Project Information

Project ID: 215129 DEA: 050N73U4 EFIS: 0520000166 QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-7.3/9.6
Work Description: Segment 4C - Summerland: Construct HOV lanes and rehabilitation. Source inspection of sign structure trusses, lighting structures, steel soldier piles, epoxy coated rebar, headed rebar, welded hoops, column pins.
Location Description: SUMMERLAND FROM 0.2 MILES NORTH OF PARDARO LANE OVERCROSSING TO SAN YSIDRO CREEK BRIDGE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: PO Box 6744, Santa Barbara , CA 93111
Resident Engineer: Tristan Gebhart Structure Rep.: Emiliano Berntsen

Sample Information

DIME Sample ID: 2021-10-20-41
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 10/20/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/17/2021
The quantity of what the sample constitutes: 3 cylinders
A brief description of the sample: CT 7.18 C+F 25% 1"/PGUHR 4P00 in
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Hanson - Goleta

Material Information

The concrete mix design number: 725A1Z0P
The truck number from where the sample was collected: 545D
The batch plant ticket number from where the sample was collected: 550496
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: SB Hwy 101 Summerland Pile 120
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results