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Sample Record for 2014-09-22-11

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

Project Information

Project ID: 209175 DEA: 030F2204 EFIS: 0300000072 QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-50-R30.7/R31.7
Work Description: REPLACE BRIDGE.
Location Description: SLY PARK UNDERCROSSING
Contractor Address: P.O. Box 1508 , Rancho Cordova, CA 95741
Resident Engineer: Jarrett Woodruff Structure Rep.: Brandon Miller

Sample Information

DIME Sample ID: 2014-09-22-11
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Sacramento Sanders Structures Construction Field Office
Sample Organization Contact: (916) 505-6839
Type of Sample: Verification
Type of Material: Concrete
Sample Taken Date: 09/22/2014
Date that the sample was received by the laboratory/organization performing the testing: 09/23/2014
The quantity of what the sample constitutes: 2 concrete cylinders
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Other
Laboratory sample identification: Unknown
Structure unique identifier: 25 0042
Structure name: Sly Park Rd UC
The fabricator/manufacturer/facility name: Jobsite

Material Information

The concrete mix design number: F628AFST0
The truck number from where the sample was collected: 25
The batch plant ticket number from where the sample was collected: 1050222
Concrete batch plant: 1B
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Discharge from concrete truck into wheelbarrow
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: 2014-09-22-11-1
Test Method: ASTM C1064-08: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 10/15/2014
Date Tested: 10/22/2014
Submitted By Organization: CT D03 - Sacramento Sanders Structures Construction Field Office
Organization Address: 3976 Durock Road, Suite 102,
Organization City: Shingle Springs
Organization State: CA
Organization Zipcode: 95686
Organization Email:
Organization Phone: (530) 821-8266
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Temperature 82 F