Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994394 DEA: 051M4504 EFIS: 0519000153
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-236-5.4
Work Description: RETAINING WALL, PAVEMENT, DRAINAGE & PERMANENT EROSION CONTROL. Heartwood Hill
Location Description: SANTA CRUZ COUNTY NEAR BOULDER CREEK AT 1.1 MILES NORTH OF BOULDER CREEK BRIDGE
Contractor Name: GORDON N BALL INC
Contractor Address: 333 CAMILLE AVENUE, ALAMO CA 94507
Resident Engineer: Farshad Keshavarzi Structure Rep.: James Wilcenski
DIME Sample ID: 2023-06-30-73
TL Number from the TL Form:
Sample Submitted By Organization: RMA Group - Rancho Cordova
Sample Organization Contact: (916) 631-7194
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 06/30/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/30/2023
The quantity of what the sample constitutes: 100 cy
A brief description of the sample: concrete
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
The truck number from where the sample was collected: 108
The batch plant ticket number from where the sample was collected: 370120
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-06-30-73-1
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 11/10/2023
Date Tested: 06/30/2023
Submitted By Organization: RMA Group - Rancho Cordova
Organization Address: 3150 Fitzgerald Road,
Organization City: Rancho Cordova
Organization State: CA
Organization Zipcode: 95742
Organization Email: mlowrance@rmacompanies.com
Organization Phone: (916) 631-7194
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2023-06-30-73-2
Test Method: ASTM C143-15a: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 11/10/2023
Date Tested: 06/30/2023
Submitted By Organization: RMA Group - Rancho Cordova
Organization Address: 3150 Fitzgerald Road,
Organization City: Rancho Cordova
Organization State: CA
Organization Zipcode: 95742
Organization Email: mlowrance@rmacompanies.com
Organization Phone: (916) 631-7194
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
