Sample Record for 2021-11-09-42
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214993 DEA: 051F5004 EFIS: 0514000003
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101,135-70.6/71.2;0.1
Work Description: CONSTRUCT CONCRETE BRIDGE, BRIDGE REMOVAL, COLD PLANE, PLACE HMA.
Location Description: SANTA BARBARA COUNTY AT LOS ALAMOS ON ROUTE 101 FROM 0.3 MILE SOUTH TO 0.3 MILE NORTH OF ROUTE 101/135 SEPARATION AND ON ROUTE 135 AT ROUTE 101/135 SEPARATION
Contractor Name: CAL PORTLAND CONSTRUCTION
Contractor Address: 1625 E Donovan Road, Santa Maria, CA 93454
Resident Engineer: Jason Torres Structure Rep.: Alex Martinez
Sample Information
DIME Sample ID: 2021-11-09-42
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 11/09/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/10/2021
The quantity of what the sample constitutes: 2 - 6x12 cylinders
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kie-Con Antioch
Material Information
The concrete mix design number: 00000
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 00000
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Batch Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
Test 1 of 1
DIME Test ID: 2021-11-09-42-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C617 - Sulfur Mortar Cap
Submitted By Organization: CT HQ - QASI Bay Area Field Office
Organization Address: 690 Walnut Avenue, Suite 150,
Organization City: Vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: maged.g.armanuse@dot.ca.gov
Organization Phone: (916) 284-6784
Data has not been verified.
