Sample Record for 2024-10-20-14
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995193 DEA: 07356604 EFIS: 0719000026
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-605-R10.2/20.2
Work Description: LANE & SLAB REPLACEMENT, COLD PLANE & HMA OVERLAY.
Location Description: LOS ANGELES COUNTY IN SANTA FE SPRINGS, PICO RIVERA, WHITTIER, CITY OF INDUSTRY AND EL MONTE FROM TELEGRAPH ROAD UNDERCROSSING TO ROUTE 605/10 SEPARATION
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Jerome Arabe Structure Rep.: Tien Chu
Sample Information
DIME Sample ID: 2024-10-20-14
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: 10/20/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/20/2024
The quantity of what the sample constitutes: 10 cubic yards
A brief description of the sample: A set of 3 JPCP RSC beams
From where was the sample collected: Job Site
Laboratory sample identification: 24-3234
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: N/A
Material Information
The concrete mix design number: VCTS675
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 1
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.:
Test Results
