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: 2023-10-20-74
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 10/20/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/23/2023
The quantity of what the sample constitutes: Concrete
A brief description of the sample: Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 36-0124
Structure name: Chanticleer Ave POC
The fabricator/manufacturer/facility name: Las Animas Concrete
The concrete mix design number: 713W25S
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: na
Concrete batch plant: Las Animas Concrete
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Chute
Where the material sample would have been placed if not sampled: CIDH to cutoff Bent #6
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-10-20-74-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 01/25/2024
Date Tested: 11/20/2023
Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Organization Address: 1529 Salinas Highway,
Organization City: Monterey
Organization State: CA
Organization Zipcode: 93940
Organization Email: wesley.rider@dot.ca.gov
Organization Phone: (831) 818-0254
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
DIME Test ID: 2023-10-20-74-3
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 01/25/2024
Date Tested: 10/20/2023
Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Organization Address: 1529 Salinas Highway,
Organization City: Monterey
Organization State: CA
Organization Zipcode: 93940
Organization Email: wesley.rider@dot.ca.gov
Organization Phone: (831) 818-0254
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
