Sample Record for 2023-02-01-25
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215753 DEA: 050N72U4 EFIS: 0520000169
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-4.4/R7.7
Work Description: Please cc Office Engineer Ni Nyoman Paul on reports sent to RE and SR. Construct High Occupancy Vehicle (HOV) lanes on U.S. Route 101 and rehabilitation - Segment 4B.
Location Description: 101 freeway in Summerland, CA
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 5335 Debbie Road, Santa Barbara, CA 93111
Resident Engineer: Luobao Cai Structure Rep.: Emiliano Berntsen
Sample Information
DIME Sample ID: 2023-02-01-25
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: 02/01/2023
Date that the sample was received by the laboratory/organization performing the testing: 02/01/2023
The quantity of what the sample constitutes: 600 CY
A brief description of the sample: CRCP Concrete
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Portable Plant at Padaro
Material Information
The concrete mix design number: 231
The truck number from where the sample was collected: 1990
The batch plant ticket number from where the sample was collected: 11827
Concrete batch plant: Granites Portable 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: 2023-02-01-25-1
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Verified Date: 02/13/2023
Date Tested: 02/01/2023
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: retest on this truck due to failure on previous load
Test Result Compliance: complies
Additional Comments When Verified:
