Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994326 DEA: 051C3604 EFIS: 0512000134
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-217-0.9/1.4
Work Description: REPLACE BRIDGE.
Location Description: SANTA BARBARA COUNTY NEAR GOLETA FROM 0.2 MILE EAST OF GOLETA SLOUGH BRIDGE TO 0.4 MILE EAST OF SAN JOSE CREEK BRIDGE
Contractor Name: MCM CONSTRUCTION
Contractor Address: 6413 32nd Street, North Highlands, Ca 95660
Resident Engineer: Manny Yogarajah Structure Rep.: Alis Chhay
DIME Sample ID: 2023-11-10-75
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: 11/10/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/10/2023
The quantity of what the sample constitutes: 24 CY
A brief description of the sample: QC Sampling Data
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kie-Con Antioch
The concrete mix design number: K5070-4212
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 120092
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from a wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-11-10-75-1
Test Method: ASTM C39-17a: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Verified Date: 01/17/2024
Date Tested: 12/08/2023
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: 28 day avg. of 10,860psi
Test Result Compliance:
Additional Comments When Verified:
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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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no data
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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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