Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215220 DEA: 07210624 EFIS: 0719000068
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA,SBD-71-1.8/R4.7&R0.0/R0.2
Work Description: PLACE STRUCTURE CONCRETE RETAINING WALLS & BOX CULVERT AND PLACE JPCP.
Location Description: IN LOS ANGELES AND SAN BERNARDINO COUNTIES IN POMONA AND CHINO HILLS FROM 0.2 MILE SOUTH OF MISSION BOULEVARD OVERCROSSING TO 0.2 MILE OF SAN BERNARDINO COUNTY LINE.
Contractor Name: OHL USA
Contractor Address: 1920 Main Street, Suite 310, Irvine, California 92614
Resident Engineer: Michael Wang Structure Rep.: Ryan Valentine
DIME Sample ID: 2024-12-23-28
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: Aggregate
Sample Taken Date: 12/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/23/2024
The quantity of what the sample constitutes: 2000 SY
A brief description of the sample: Subgrade
From where was the sample collected: Job Site
Laboratory sample identification: 24-3973
Structure unique identifier:
Structure name: Subgrade backfill compaction SB A1 Line (RETEST)
The fabricator/manufacturer/facility name: N/A
Source Identification (SMARA, name of Pit or Job Site): N/A
The fabricator's/manufacturer's product name for the sample: Subgrade
The fabricator/manufacturer designation for the sample: Compaction testing
The plant number:
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled: Jobsite
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
