Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995085 DEA: 07322904 EFIS: 0716000059
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-27-0.0/18.6
Work Description: REMOVE EXISTING AC PAVEMENT & HMA OVERLAY.
Location Description: LOS ANGELES COUNTY IN AND NEAR LOS ANGELES FROM ROUTE 1 TO DEVONSHIRE STREET
Contractor Name: C. A. RASMUSSEN, INC.
Contractor Address: 28548 Livingston Ave, Valencia, CA 91355
Resident Engineer: Ravin Maru Structure Rep.: Unknown
DIME Sample ID: 2024-09-13-41
TL Number from the TL Form:
Sample Submitted By Organization: Alta Vista Solutions - Whittier
Sample Organization Contact: (510) 542-9827
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/13/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/13/2024
The quantity of what the sample constitutes: 10 cubic yards
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 24-2827
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: N/A
The concrete mix design number: S30C396L0A
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 253416
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-09-13-41-1
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 09/18/2024
Date Tested: 09/13/2024
Submitted By Organization: Alta Vista Solutions - Whittier
Organization Address: 12409 Slauson Avenue, Suite I,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90606
Organization Email: nicholas.hoffmann@oneatlas.com
Organization Phone: (510) 542-9827
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
