Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994968 DEA: 120M82C4 EFIS: 1219000036
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-1-7.9/10.5
Work Description: Place RHMA-G and minor concrete and modify electrical system.
Location Description: In Orange County In Laguna Beach, On State Route 1 (Also Known As Pacific Coast Highway Or Sr-1) From Ruby Street (Pm 7.9) To Ledroit
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Artin Merati Structure Rep.: Unknown
DIME Sample ID: 2024-09-30-38
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 09/30/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/03/2024
The quantity of what the sample constitutes: 4 Bags Combined Agg(3/4,1/2,3/8 man sand), 1 bag hi-nat, 1 bag crum
A brief description of the sample: 3/4" RHMA G SP 0.75% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0511G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond-Irwindale
Source Identification (SMARA, name of Pit or Job Site): 91-19-0052
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: 4 Bags CMB Agg(3/4,1/2,3/8" MAN SAND),1 bag Hi-Nat,1 Bag Crum
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 300072 IRW
Lot number:
Sublot number:
Aggregate Mix Number:
