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Sample Record for 2022-01-21-13

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

Project Information

Project ID: 214579 DEA: 010B0904 EFIS: 0100020444 QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-8.2/8.7
Work Description: BRIDGE REPLACEMENT
Location Description: DEL NORTE COUNTY NEAR KLAMATH AT PANTHER CREEK BRIDGE AND AT HUNTER CREEK BRIDGE
Contractor Name: Golden State Bridge, Inc
Contractor Address: 3701 Mallard Dr., Benicia, CA 94510
Resident Engineer: Ryan Dunne Structure Rep.: Brian Cinkutis

Sample Information

DIME Sample ID: 2022-01-21-13
TL Number from the TL Form:
Sample Submitted By Organization: Kie-Con, Incorporated - Antioch
Sample Organization Contact: (925) 331-7122
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 01/21/2022
Date that the sample was received by the laboratory/organization performing the testing: 01/21/2022
The quantity of what the sample constitutes: 1ea
A brief description of the sample: Composite Concrete Sample
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name: Knuckle
The fabricator/manufacturer/facility name: Kie-Con Antioch

Material Information

The concrete mix design number: K4200 CP1A
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 113364
Concrete batch plant: KieCon
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: At casting bed
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 3

DIME Test ID: 2022-01-21-13-1
Test Method: ASTM C1064-08: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 01/26/2022
Date Tested: 01/21/2022
Submitted By Organization: Kie-Con, Incorporated - Antioch
Organization Address: 3551 Wilbur Ave,
Organization City: Antioch
Organization State: CA
Organization Zipcode: 94509
Organization Email: gregory.lask@kiewit.com
Organization Phone: (925) 331-7122
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Temperature 71 F

Test 2 of 3

DIME Test ID: 2022-01-21-13-2
Test Method: ASTM C143-10a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 01/26/2022
Date Tested: 01/21/2022
Submitted By Organization: Kie-Con, Incorporated - Antioch
Organization Address: 3551 Wilbur Ave,
Organization City: Antioch
Organization State: CA
Organization Zipcode: 94509
Organization Email: gregory.lask@kiewit.com
Organization Phone: (925) 331-7122
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Slump 8.25 inch

Test 3 of 3

DIME Test ID: 2022-01-21-13-3
Test Method: CTM 518-June 2010: Method of Test for Unit Weight of Fresh Concrete
Verified Date: 01/26/2022
Date Tested: 01/21/2022
Submitted By Organization: Kie-Con, Incorporated - Antioch
Organization Address: 3551 Wilbur Ave,
Organization City: Antioch
Organization State: CA
Organization Zipcode: 94509
Organization Email: gregory.lask@kiewit.com
Organization Phone: (925) 331-7122
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Unit weight of the concrete 151.6 lb/ft^3
Cement content 795.76 lb/yd^3