Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208959 DEA: 04265604 EFIS: 0400000743 COOP: 042390A1
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-1-40.64/40.95
Work Description: REPLACEMENT OF THE EXISTING SAN PEDRO CREEK BRIDGE
Location Description: ON ROUTE 1 IN SAN MATEO COUNTY
Contractor Name: Graniterock Construction
Contractor Address: 120 Graniterock Way, San Jose, CA 95136
Resident Engineer: Charles Koos Structure Rep.: Clifford Law
DIME Sample ID: 2015-02-03-3
TL Number from the TL Form: 87379
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Informational
Type of Material: Concrete
Sample Taken Date: 02/03/2015
Date that the sample was received by the laboratory/organization performing the testing: 02/04/2015
The quantity of what the sample constitutes: 2
A brief description of the sample: Voided Slab
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Voided Slab
The fabricator/manufacturer/facility name: KieCon
The concrete mix design number: K5060503A
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: 00000
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: source
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2015-02-03-3-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C617/CTM521
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.
