Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993868 DEA: 050C7324 EFIS: 0512000228
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-13.4/14.9
Work Description: CONSTRUCT PEDESTRIAN OVERCROSSING AND AUXILIARY LANE.
Location Description: SANTA CRUZ COUNTY IN AND NEAR CITY OF CAPITOLA FROM 0.2 MILE SOUTH OF 41ST AVENUE OVERCROSSING TO 0.2 MILE NORTH OF SOQUEL DRIVE OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 585 BEACH STREET, WATSONVILLE CA 95076
Resident Engineer: Gareth Gill Structure Rep.: Chris McDermott
DIME Sample ID: 2023-10-03-21
TL Number from the TL Form:
Sample Submitted By Organization: Granite Construction Company - Watsonville
Sample Organization Contact: (831) 763-5591
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 10/03/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/03/2023
The quantity of what the sample constitutes: Cylinders
A brief description of the sample: Concrete Test Samples
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Las Animas Concrete
The concrete mix design number: C2S30, 759W50S, 73W25S
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 2
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Back of Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
