Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215358 DEA: 040K5104 EFIS: 0416000096
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-11.2
Work Description: IRWIN CR BR REHAB CULVERT
Location Description: MARIN COUNTY IN SAN RAFAEL AT IRWIN CREEK (BR NO. 27-0097)
Contractor Name: DISNEY CONSTRUCTION, INC.
Contractor Address: 533 Airport Blvd, Suite 120, Burlingame, CA 94010
Resident Engineer: Isaac Mai Structure Rep.: Long Ly
DIME Sample ID: 2022-09-02-74
TL Number from the TL Form:
Sample Submitted By Organization: Smith-Emery SF
Sample Organization Contact: (415) 642-5422
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/02/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/05/2022
The quantity of what the sample constitutes: 10CY
A brief description of the sample: Type II Cement
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Shamrock Concrete
The concrete mix design number: SL3172CEA
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: load 1
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: hopper
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-09-02-74-1
Test Method: ASTM C39-17a: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Submitted By Organization: Smith-Emery SF
Organization Address: 1940 Oakdale Avenue,
Organization City: San Francisco
Organization State: CA
Organization Zipcode: 94124
Organization Email: lpaparelli@smithemerysf.com
Organization Phone: (415) 642-5422
Data has not been verified.
