Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212737 DEA: 060S8304 EFIS: 0615000046
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-5-44.4-45.4
Work Description: TUMEY GULCH ABUTMENT REHAB BR# 42-0246L/R.
Location Description: IN FRESNO COUNTY AT TUMEY GULCH.
Contractor Name: Bruce Shumacher
Contractor Address: 2716 S Granite Ct, Fresno, CA 93706
Resident Engineer: Cary Cruz Structure Rep.: Ben Holton
DIME Sample ID: 2023-05-31-37
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 417-5341
Type of Sample: Verification
Type of Material: Concrete
Sample Taken Date: 05/31/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/31/2023
The quantity of what the sample constitutes: 300 Cy
A brief description of the sample: Structural Concrete - Abutment Footing
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 42-0455L
Structure name: Tumey Gulch Bridge
The fabricator/manufacturer/facility name: Don Chapin
The concrete mix design number: G67534SA
The truck number from where the sample was collected: 3
The batch plant ticket number from where the sample was collected: 420213
Concrete batch plant: Chapin Ready Mix
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: SB Bridge Abutment 2 Footing
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-05-31-37-1
Test Method: ASTM C143-15a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Submitted By Organization: CT D06 - Millbrook Field Laboratory
Organization Address: 3240 North Millbrook Avenue,
Organization City: Fresno
Organization State: CA
Organization Zipcode: 93726
Organization Email: tomas.silva@dot.ca.gov
Organization Phone: (559) 417-5341
Data has not been verified.
DIME Test ID: 2023-05-31-37-2
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Submitted By Organization: CT D06 - Millbrook Field Laboratory
Organization Address: 3240 North Millbrook Avenue,
Organization City: Fresno
Organization State: CA
Organization Zipcode: 93726
Organization Email: tomas.silva@dot.ca.gov
Organization Phone: (559) 417-5341
Data has not been verified.
