Sample Record for 2025-01-10-40
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214649 DEA: 07316004 EFIS: 0715000194
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-14-60.70
Work Description: REHABILITATION FOR THE ON/OFF RAMPS AND ADJACENT SHOULDERS. UPGRADING METAL BEAM GUARDRAILS, AC DIKES, SIGN PANELS, CURB RAMPS, TRAFFIC LOOPS DETECTORS, AND SOME OTHER HIGHWAY APPURTENANCES.
Location Description: ROUTE 14 FROM PALMDALE BLVD TO KERN COUNTRY LINE.
Contractor Name: Guy F. Atkinson Construction LLC
Contractor Address: 18201 Von Karman Ave, Suite 800, Irvine, CA 92612
Resident Engineer: James Shih Structure Rep.: Hossein Sabbagh
Sample Information
DIME Sample ID: 2025-01-10-40
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: 01/10/2025
Date that the sample was received by the laboratory/organization performing the testing: 01/10/2025
The quantity of what the sample constitutes: 6 CY
A brief description of the sample: 6 x 12 LCB Cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 25-0145-0146-0147
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: N/A
Material Information
Source Identification (SMARA, name of Pit or Job Site): N/A
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
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:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 12622-LCB-1
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
