Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215180 DEA: 060Q9204 EFIS: 0614000010 COOP: 061764
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-99-10.4/21.2
Work Description: CONSTRUCT CRCP AND HMA (TYPE A) PAVEMENT.
Location Description: KERN COUNTY IN AND NEAR BAKERSFIELD FROM 0.4 MILE SOUTH OF OLD US 99 OVERCROSSING TO 0.1 MILE NORTH OF WHITE LANE OVERCROSSING
Contractor Name: Griffith Company
Contractor Address: 1128 Carrier Parkway, Bakersfield ,CA 93308
Resident Engineer: James Burford Structure Rep.: Ulysis Baal
DIME Sample ID: 2023-07-26-24
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Bakersfield Field Laboratory
Sample Organization Contact: 661-549-8281
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 07/26/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/26/2023
The quantity of what the sample constitutes: 10 CY load 1
A brief description of the sample: CRCP - sample for testing
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Hwy 223 off ramp sb 99
The concrete mix design number: G3-21-PCC-263
The truck number from where the sample was collected: 29
The batch plant ticket number from where the sample was collected: 1
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Back of Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-07-26-24-1
Test Method: CTM 557-July 2012: Method of Test for Temperature of Freshly Mixed Portland Cement Concrete
Verified Date: 07/27/2023
Date Tested: 07/26/2023
Submitted By Organization: CT D06 - Bakersfield Field Laboratory
Organization Address: 1824 Norris Road,
Organization City: Bakersfield
Organization State: CA
Organization Zipcode: 93308
Organization Email: kulwinder.rai@dot.ca.gov
Organization Phone: (661) 549-8281
General Comments for this Test: P-1 load wasted by contractor due to temperature of concrete
Test Result Compliance: does not comply
Additional Comments When Verified:
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Temperature of the freshly mixed concrete
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92 F
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