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Sample Record for 2023-01-19-43

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 993235 DEA: 051H4504 EFIS: 0516000075 QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-154-R31.8/R32.1
Work Description: CONSTRUCT CIDH CONCRETE PILES AND STRUCTURAL CONCRETE BRIDGE.
Location Description: SANTA BARBARA COUNTY IN AND NEAR SANTA BARBARA FROM PRIMAVERA ROAD UNDERCROSSING TO LA COLINA ROAD UNDERCROSSING
Contractor Name: CA Rasmussen
Contractor Address: 28548 LIVINGSTON AVENUE, VALENICA CA 91355
Resident Engineer: Jeffery Finn Structure Rep.: Emiliano Berntsen

Sample Information

DIME Sample ID: 2023-01-19-43
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Sample Organization Contact: (805) 621-3616
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 01/19/2023
Date that the sample was received by the laboratory/organization performing the testing: 01/19/2023
The quantity of what the sample constitutes: 14 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: Cemex

Material Information

The concrete mix design number: 1612111
The truck number from where the sample was collected: 10070501
The batch plant ticket number from where the sample was collected: 30597955
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Discharge from concrete truck into wheelbarrow.
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 1

DIME Test ID: 2023-01-19-43-1
Test Method: ASTM C143-15a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 01/31/2023
Date Tested: 01/19/2023
Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Organization Address: 21 Griffin Road North,
Organization City: Windsor
Organization State: CT
Organization Zipcode: 06095-1590
Organization Email: dlachaine@trccompanies.com
Organization Phone: (805) 621-3616
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Slump 4 inch