Sample Record for 2023-06-15-64
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214469 DEA: 030H08U4 EFIS: 0319000029
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-50-L0.2/R6.1
Work Description: Sac 50 Design Build PLEASE NOTE THAT DESIGN BUILDER MUST PERFORM QUALITY VALIDATION TESTING IN ACCORDANCE WITH THE MATERIAL CONTROL SCHEDULE (MCS) FOR ITEMS SUCH AS STRANDS, HS BOLTS, ELASTOMERIC BEARING PADS, JOINT SEALANTS, COUPLERS & WELDED HOOPS, ETC
Location Description: FROM 0.1 MILE EAST OF I-5 TO 0.8 MILE EAST OF WATT AVE
Contractor Name: FLATIRON WEST INC
Contractor Address: 2100 Goodyear Rd., Benicia, CA 94510
Resident Engineer: Jim Rogers Structure Rep.: Daniel Eggers
Sample Information
DIME Sample ID: 2023-06-15-64
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 06/15/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/16/2023
The quantity of what the sample constitutes: 0-144 CY
A brief description of the sample: 6x12 cylinder
From where was the sample collected: Job Site
Laboratory sample identification: C061423-500
Structure unique identifier:
Structure name: Bridge 11, Frame 1, Stem and Soffit
The fabricator/manufacturer/facility name: Cemex
Material Information
The concrete mix design number: 1615776
The truck number from where the sample was collected: 10072267
The batch plant ticket number from where the sample was collected: 30784245
Concrete batch plant: Cemex West Sacramento
The fabricator/manufacturer designation for the sample: Structural Concrete
A detailed description of where the material sample was collected: Bridge 11, frame 1, stem and soffit
Where the material sample would have been placed if not sampled: Stem and Soffit
From Lot No.:
Bag Lot No.:
Test Results
