Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214579 DEA: 010B0904 EFIS: 0100020444
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-8.2/8.7
Work Description: Panther Creek & Hunter Creek Bridges
Location Description: DEL NORTE COUNTY NEAR KLAMATH AT PANTHER CREEK BRIDGE AND AT HUNTER CREEK BRIDGE
Contractor Name: Golden State Bridge, Inc
Contractor Address: 3701 Mallard Dr., Benicia, CA 94510
Resident Engineer: Ryan Dunne Structure Rep.: Brian Cinkutis
DIME Sample ID: 2023-06-21-32
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Crescent City Field Laboratory
Sample Organization Contact: (707) 496-5581
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 06/21/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/21/2023
The quantity of what the sample constitutes: 4 Bags
A brief description of the sample: 3/4 minus agg base
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Panther Creek
The fabricator/manufacturer/facility name: Tidewater Smith River
Source Identification (SMARA, name of Pit or Job Site): 91-53-0015
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: A detailed description of where the material sample was collected
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2023-06-21-32-1
Test Method: CTM 216-June 2011: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates
Submitted By Organization: CT D01 - Crescent City Field Laboratory
Organization Address: 207 Price Mall,
Organization City: Crescent City
Organization State: CA
Organization Zipcode: 95531
Organization Email: clayton.malmberg@dot.ca.gov
Organization Phone: (707) 496-5581
Data has not been verified.
DIME Test ID: 2023-06-21-32-2
Test Method: CTM 231-March 2013: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates Using Nuclear Gages
Submitted By Organization: CT D01 - Crescent City Field Laboratory
Organization Address: 207 Price Mall,
Organization City: Crescent City
Organization State: CA
Organization Zipcode: 95531
Organization Email: clayton.malmberg@dot.ca.gov
Organization Phone: (707) 496-5581
Data has not been verified.
