Sample Record for 2025-01-03-16
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993870 DEA: 120R5604 EFIS: 1218000117
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5,55,73,91,133,405-var
Work Description: PLACE RHMA-G, HMA, SLAB REPLACEMENT AND JPCP.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS
Contractor Name: SECURITY PAVING COMPANY INC.
Contractor Address: 3075 Towngate Road, St. 200, Westlake Village, CA 91361
Resident Engineer: Roy Rivera Structure Rep.: Vian Ghazi
Sample Information
DIME Sample ID: 2025-01-03-16
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 01/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 01/03/2025
The quantity of what the sample constitutes: 60 cy
A brief description of the sample: concrete
From where was the sample collected: Manufacturer
Laboratory sample identification: 24-0005
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NATIONAL READY MIXED CONCRETE
Material Information
The concrete mix design number: S85C440T1C
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: Batch Plant
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
