Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994209 DEA: 010E7904 EFIS: 0115000021
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-254-4.2/4.2
Work Description: Project Name: Fish Creek Bridge (Bridge No. 04-0317)
Location Description: HUMBOLDT COUNTY NEAR PHILLIPSVILLE AT 3.3 MILES NORTH OF OHMAN CREEK BRIDGE
Contractor Name: Mercer-Fraser Company
Contractor Address: PO Box 1006, Eureka, CA 95502
Resident Engineer: Brian Apple Structure Rep.: George Moore
DIME Sample ID: 2023-08-04-97
TL Number from the TL Form:
Sample Submitted By Organization: Kie-Con, Incorporated - Antioch
Sample Organization Contact: (925) 331-7122
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/04/2023
The quantity of what the sample constitutes: 1
A brief description of the sample: 28 day break data
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: KieCon
The concrete mix design number: k4060-8312
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 119004
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete sample from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-08-04-97-1
Test Method: ASTM C39-18: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Verified Date: 09/27/2023
Date Tested: 09/01/2023
Submitted By Organization: Kie-Con, Incorporated - Antioch
Organization Address: 3551 Wilbur Avenue,
Organization City: Antioch
Organization State: CA
Organization Zipcode: 94509
Organization Email: gregory.lask@kiewit.com
Organization Phone: (925) 331-7122
General Comments for this Test: 9,240psi
Test Result Compliance:
Additional Comments When Verified:
Unit system used?
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US Units
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Number of specimens
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3
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Test performed
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With density determined by dimension measurements
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Average cylinder density (to nearest 1 pcf)
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0 lb/ft^3
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Average diameter of cylinder 1
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4.00 in
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Average diameter of cylinder 2
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4.00 in
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Average diameter of cylinder 3
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4.00 in
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Comment on any defect in either specimen or caps (Max 250 Characters)
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no data
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