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Sample Record for 2023-07-28-28

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 993715 DEA: 010G1404 EFIS: 0116000129 QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-96,169-VAR
Work Description: HUM 96-169 5 Bridges Rail Upgrade (Do not include in project name: STRUCTURAL STEEL, CONCRETE BARRIER, POLYESTER CONCRETE OVERLAY)
Location Description: HUMBOLDT COUNTY ON ROUTES 96 AND 169 AT VARIOUS LOCATIONS (Bridge Nos. 04-0215, 04-0059, 04-0063, 04-0225, 04-0061)
Contractor Name: Steelhead Constructors JV
Contractor Address: P.O. Box 536, Palo Cedro, CA 96073
Resident Engineer: Efren Banuelos Structure Rep.: Laura Cangas

Sample Information

DIME Sample ID: 2023-07-28-28
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 07/28/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/29/2023
The quantity of what the sample constitutes: 16
A brief description of the sample: Structural concrete polymer fiber
From where was the sample collected: Job Site
Laboratory sample identification: C0163
Structure unique identifier: 12-04-0059
Structure name: Aikens Creek Bridge
The fabricator/manufacturer/facility name: Mercer Fraser Willow Creek Plant

Material Information

The concrete mix design number: MFWCBRDKSLAG
The truck number from where the sample was collected: 695
The batch plant ticket number from where the sample was collected: WC01209
Concrete batch plant: Willow Creek
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Discharge chute from back of truck
Where the material sample would have been placed if not sampled: Aikens Creek Bridge Deck Overhang
From Lot No.:
Bag Lot No.:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2023-07-28-28-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 08/25/2023
Date Tested: 08/25/2023
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1726 Albee Street,
Organization City: Eureka
Organization State: CA
Organization Zipcode: 95501
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test: 28 Day Break
Test Result Compliance:
Additional Comments When Verified:
Unit system used? US Units
Number of specimens 2
Test performed With no density determined
Capped in accordance with? ASTM C617 - Sulfur Mortar Cap
Average diameter of cylinder 1 4.00 in
Average diameter of cylinder 2 4.00 in
Cross sectional area of cylinder 1 12.6 in^2
Cross sectional area of cylinder 2 12.6 in^2
Compressive strength (to nearest 10 psi) 6680 psi
Maximum load on cylinder 1 82070 lb
Maximum load on cylinder 2 85880 lb
Type of fracture pattern of cylinder 1 2
Type of fracture pattern of cylinder 2 2
Comment on any defect in either specimen or caps (Max 250 Characters) no data
Correction factor for cylinder 1 1
Correction factor for cylinder 2 1
Age of specimen 28 days
Age of specimen in hours 0 hours

Test 2 of 3

DIME Test ID: 2023-07-28-28-2
Test Method: CTM 556-March 2016: Method of Test for Slump of Fresh Portland Cement Concrete
Verified Date: 08/02/2023
Date Tested: 07/28/2023
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1726 Albee Street,
Organization City: Eureka
Organization State: CA
Organization Zipcode: 95501
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Slump 7.5 inch

Test 3 of 3

DIME Test ID: 2023-07-28-28-3
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 08/02/2023
Date Tested: 07/28/2023
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1726 Albee Street,
Organization City: Eureka
Organization State: CA
Organization Zipcode: 95501
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Temperature 84 F