Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212720 DEA: 07291404 EFIS: 0712000094
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1-55-58
Work Description: TRANCAS CREEK BRIDGE REPLACEMENT
Location Description: IN LOS ANGELES IN CITY OF MALIBU AT TRANCAS CREEK BRIDGE (53-0027).
Contractor Name: STACY AND WITBECK, INC.
Contractor Address: 3939 Atlantic Ave Suite 114, Long Beach, CA 90807
Resident Engineer: Gilbert Trujillo Structure Rep.: Frank Lofti
DIME Sample ID: 2022-09-02-65
TL Number from the TL Form:
Sample Submitted By Organization: Bethlehem Construction, Incorporated
Sample Organization Contact: (661) 758-1001
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 09/02/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/02/2022
The quantity of what the sample constitutes: 24CY
A brief description of the sample: Voided Slab
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bethlehem Construction
The concrete mix design number: SCC-ASH-32_3
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 0009970
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: MIDDLE OF THE LOAD
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-09-02-65-1
Test Method: ASTM C39-18: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Submitted By Organization: Bethlehem Construction, Incorporated
Organization Address: 425 J Street,
Organization City: Wasco
Organization State: CA
Organization Zipcode: 93280
Organization Email: keithl@bethlehemconstruction.com
Organization Phone: (661) 758-1001
Data has not been verified.
