Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215050 DEA: 080R1424 EFIS: 0815000201
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-R125.0/R154.6
Work Description: ROADWAY EXCAVATION, IMPORT BORROW AND REGRADE THE MEDIAN SLOPE.
Location Description: SAN BERNARDINO COUNTY FROM 4.5 MILES EAST OF HOMER WASH BRIDGE TO ARIZONA STATE LINE
Contractor Name: Ames Construction
Contractor Address: 391 N. MAIN STREET, CORONA CA 92880
Resident Engineer: Darcy Davis Structure Rep.: Unknown
DIME Sample ID: 2022-01-12-57
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: 01/12/2022
Date that the sample was received by the laboratory/organization performing the testing: 01/12/2022
The quantity of what the sample constitutes: 2 cylinders
A brief description of the sample: structural concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Bullhead City AZ
The concrete mix design number: 1619144
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 46769862
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: S36 W Walls and DS42 RCB Deck Walls
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-01-12-57-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: Sequoia Consultants
Organization Address: 361 West Grove Avenue,
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email: sranjan@sequoiacon.com
Organization Phone: 1 (714) 974-6316
Data has not been verified.
