Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994654 DEA: 07313504 EFIS: 0715000090
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA,VEN-1-37.7/62.9,0.0/0.9
Work Description: REMOVE AND CONSTRUCT BRIDGE AND CULVERTS.
Location Description: LOS ANGELES AND VENTURA COUNTIES AT VARIOUS LOCATIONS FROM 0.4 MILE SOUTH OF TEMESCAL CANYON ROAD TO 0.1 MILE NORTH OF TONGA STREET
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Dan Leon Structure Rep.: Aziz Maghsoudloo
DIME Sample ID: 2024-04-16-112
TL Number from the TL Form: Unknown
Sample Submitted By Organization: G3 Quality, Incorporated - Cerritos
Sample Organization Contact: (562) 321-9840
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 04/16/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/17/2024
The quantity of what the sample constitutes: 21
A brief description of the sample: 4x8 cylinders
From where was the sample collected: Job Site
Laboratory sample identification: Set 1
Structure unique identifier: 00-0000
Structure name: RW Abut 1R CIDH #24
The fabricator/manufacturer/facility name: Job Site
The concrete mix design number: SL750450WH8
The truck number from where the sample was collected: Load 1
The batch plant ticket number from where the sample was collected: 0
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Set 1
A detailed description of where the material sample was collected: RW Abut 1R CIDH #24
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
DIME Test ID: 2024-04-16-112-1
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Verified Date: 12/06/2024
Date Tested: 04/16/2024
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
