Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994087 DEA: 051G4104 EFIS: 0515000012
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-4.0/4.8
Work Description: Santa Claus Lane Bike Path - !!Charge time to 05-0N72U4 per Project Manager / Corridor Manager!!
Location Description: !!Charge time to 05-0N72U4 per Project Manager / Corridor Manager!!
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 5335 Debbie Road, Santa Barbara, CA 93111
Resident Engineer: Luobao Cai Structure Rep.: Josh Madrigal
DIME Sample ID: 2023-04-03-72
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Sample Organization Contact: (805) 621-3616
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/03/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/04/2023
The quantity of what the sample constitutes: 9.5 CY
A brief description of the sample: PCC
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marrieta, Goleta
The concrete mix design number: 725A1Z0P
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 3433154
Concrete batch plant: Martin Marietta
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:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-04-03-72-1
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 08/17/2023
Date Tested: 04/03/2023
Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Organization Address: 21 Griffin Road North,
Organization City: Windsor
Organization State: CT
Organization Zipcode: 06095-1590
Organization Email: dlachaine@trccompanies.com
Organization Phone: (805) 621-3616
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
DIME Test ID: 2023-04-03-72-2
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 08/17/2023
Date Tested: 04/03/2023
Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Organization Address: 21 Griffin Road North,
Organization City: Windsor
Organization State: CT
Organization Zipcode: 06095-1590
Organization Email: dlachaine@trccompanies.com
Organization Phone: (805) 621-3616
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
