Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209795 DEA: 08383504 EFIS: 0800000638
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-63.0
Work Description: REPLACE HURKEY CREEK BRIDGE
Location Description: RIVERSIDE COUNTY NEAR IDYLLWILD AT HURKEY CREEK BRIDGE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 440 SOUTH MELROSE DRIVE 200 , VISTA CA 92081
Resident Engineer: Max Quach Structure Rep.: Shukri Abouazra
DIME Sample ID: 2015-10-09-2
TL Number from the TL Form: 03
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 10/09/2015
Date that the sample was received by the laboratory/organization performing the testing: 10/13/2015
The quantity of what the sample constitutes: 4
A brief description of the sample: 6x12
From where was the sample collected: Job Site
Laboratory sample identification: 918-03
Structure unique identifier: HURKEY CREEK BRIDGE
Structure name: ABUTMENT 2 FTG
The fabricator/manufacturer/facility name: JOB
The concrete mix design number: RRM09014
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: NP
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: CHUTE
Where the material sample would have been placed if not sampled: Unknown
From Lot No.:
Bag Lot No.:
DIME Test ID: 2015-10-09-2-1
Test Method: ASTM C39-17a: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
Data has not been verified.
