Sample Record for 2025-11-03-70
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: 2025-11-03-70
TL Number from the TL Form:
Sample Submitted By Organization: Kleinfelder, Incorporated - Los Angeles
Sample Organization Contact: (909) 833-5780
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 11/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/04/2025
The quantity of what the sample constitutes: 60 CY
A brief description of the sample: Lean Concrete Base
From where was the sample collected: Job Site
Laboratory sample identification: 25-3578
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Atkinson Batch Plant
Material Information
The concrete mix design number: 12622-LCB-1
The truck number from where the sample was collected: 36
The batch plant ticket number from where the sample was collected: 7
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Truck #36
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
