Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214998 DEA: 044H0504 EFIS: 0413000080
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-12-25.8-33.3
Work Description: BRIDGE SCOUR MITIGATION
Location Description: SONOMA COUNTY NEAR SANTA ROSA AT SONOMA CREEK BRIDGE AND AT HOOKER CREEK BRIDGE
Contractor Name: Ghilotti Construction Co. (Nishit Prajapati)
Contractor Address: 246 Ghilloti Ave, Santa Rosa CA 95407
Resident Engineer: leonard brajnikoff Structure Rep.: Anthony tierra
DIME Sample ID: 2023-06-16-17
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Petaluma Field Laboratory
Sample Organization Contact: (510) 385-6841
Type of Sample: Quality Assurance
Type of Material: Concrete Core
Sample Taken Date: 06/16/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 4.74 cy
A brief description of the sample: Accelerated concrete with Flyash
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name: Hooker Creek Bridge
The fabricator/manufacturer/facility name: Shamrock Materials Petaluma
Detail description: Trial batch accelerated concrete with flyash
Structure names: Hooker creek bridge
Type of material: Concrete
