Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214562 DEA: 040J7104 EFIS: 0414000029
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-80-1.8/4.4
Work Description: RAISE BRIDGE AND PLACE STRUCTURAL CONCRETE.
Location Description: SOLANO COUNTY IN VALLEJO AT VARIOUS LOCATIONS
Contractor Name: BROSAMER & WALL, INC.
Contractor Address: 1777 Oakland Blvd., Suite 300, Walnut Creek, CA 94596
Resident Engineer: Quang Tran Structure Rep.: Mohan Ayadurai
DIME Sample ID: 2021-08-03-45
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: 08/03/2021
Date that the sample was received by the laboratory/organization performing the testing: 08/03/2021
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: Syar Vallejo
The concrete mix design number: CT072AC5
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 81143513
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Magazine street at HWY 80 abutment 1 approach slab
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2021-08-03-45-1
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 04/07/2022
Date Tested: 08/03/2021
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
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2021-08-03-45-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 04/07/2022
Date Tested: 08/03/2021
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
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
