Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214698 DEA: 120N8904 EFIS: 1214000130
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-133-8.3/M9.3
Work Description: CONSTRUCT AUXILIARY LANE.
Location Description: ORANGE COUNTY IN IRVINE FROM ROUTE 133/405 SEPARATION TO IRVINE CENTER DRIVE OVERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3200 Park Center Drive, Suite #200, Costa Mesa, CA 92626
Resident Engineer: Arezo Ghiam Structure Rep.: Michael Yee
DIME Sample ID: 2024-02-19-18
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: 02/19/2024
Date that the sample was received by the laboratory/organization performing the testing: 02/20/2024
The quantity of what the sample constitutes: 10
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: Irvine Batch Plant, National Ready Mix
The fabricator/manufacturer/facility name: Job Site
The concrete mix design number: S72C447T10
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: National Ready Mix Irvine Batch Plant
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
