Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214830 DEA: 043G6304 EFIS: 0412000409
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL-4-SCl-9 -4.75/4.9
Work Description: Saratoga Creek Bridge Rehabilitation Project
Location Description: San Jose - Saratoga Creek
Contractor Name: Myers and Sons
Contractor Address: 4600 NORTHGATE BLVD, STE 100, SACRAMENTO, CA 95834
Resident Engineer: Arif Khan Structure Rep.: OANH BUI
DIME Sample ID: 2023-09-26-2
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California Corporation - Lathrop
Sample Organization Contact: (209) 249-4700
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 09/26/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/27/2023
The quantity of what the sample constitutes: 1 cubic ft. of Concrete for Testing
A brief description of the sample: 1 cubic ft. of Concrete taken from middle of batching
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ConFab Lathrop
The concrete mix design number: VER-98LV
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 9538
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Bed Echo, Truck 1
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-09-26-2-1
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 09/29/2023
Date Tested: 09/26/2023
Submitted By Organization: Con-Fab California Corporation - Lathrop
Organization Address: 1910 Lathrop Road,
Organization City: Lathrop
Organization State: CA
Organization Zipcode: 95330
Organization Email: dannyc@confabca.com
Organization Phone: (209) 249-4717
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2023-09-26-2-2
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 09/29/2023
Date Tested: 09/26/2023
Submitted By Organization: Con-Fab California Corporation - Lathrop
Organization Address: 1910 Lathrop Road,
Organization City: Lathrop
Organization State: CA
Organization Zipcode: 95330
Organization Email: dannyc@confabca.com
Organization Phone: (209) 249-4717
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2023-09-26-2-3
Test Method: ASTM C138-17a: Standard Test Method for Density (Unit Weight), Yield, and Air Content (Gravimetric) of Concrete
Verified Date: 09/29/2023
Date Tested: 09/26/2023
Submitted By Organization: Con-Fab California Corporation - Lathrop
Organization Address: 1910 Lathrop Road,
Organization City: Lathrop
Organization State: CA
Organization Zipcode: 95330
Organization Email: dannyc@confabca.com
Organization Phone: (209) 249-4717
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Identification of concrete represented by the sample
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Bed Echo, Truck 1
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Volume of the measure
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0.25 ft^3
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Density of concrete
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151.3 lb/ft^3
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Yield of concrete
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no data
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Relative yield of the batch
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no data
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Cement content
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no data
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Air content
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2.4 %
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