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Sample Record for 2020-11-09-17

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Project Information

Project ID: 214355 DEA: 120K0214 EFIS: 1214000096 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-12.4/14.5
Work Description: South County Improvement Project (Phase 1 - Avery/Crown Valley) PLACE HMA, INSTALL CONC PAVEMENT, RETAIN WALL, MODIFY ELECT SYS. | Add one lane btwn 73 & Oso PKWY
Location Description: ORANGE COUNTY IN SAN JUAN CAPISTRANO, LAGUNA HILLS, LAGUNA NIGUEL AND MISSION VIEJO FROM 0.5 MILE SOUTH OF AVERY PARKWAY UNDERCROSSING TO 0.8 MILE NORTH OF CROWN VALLEY PARKWAY OVERCROSSING
Contractor Name: ORTIZ ENTERPRISES, INC.
Contractor Address: 6 Cushing, Suite 200, Irvine, CA 92618
Resident Engineer: Artin Merati Structure Rep.: Imad Karam

Sample Information

DIME Sample ID: 2020-11-09-17
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 11/09/2020
Date that the sample was received by the laboratory/organization performing the testing: 11/10/2020
The quantity of what the sample constitutes: 100CY
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: C110920-105
Structure unique identifier:
Structure name: Retaining Wall 738
The fabricator/manufacturer/facility name: Cemex San Juan Capistrano

Material Information

The concrete mix design number: 1614705
The truck number from where the sample was collected: 10067844
The batch plant ticket number from where the sample was collected: 29333817
Concrete batch plant: Cemex San Juan Capistrano
The fabricator/manufacturer designation for the sample: Mix
A detailed description of where the material sample was collected: Discharge chute from back of truck
Where the material sample would have been placed if not sampled: Retaining Wall
From Lot No.:
Bag Lot No.:
Test results on following page(s): 1

Test Results

Test 1 of 1

DIME Test ID: 2020-11-09-17-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: Sequoia Consultants
Organization Address: 361 West Grove Avenue,
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email: sranjan@sequoiacon.com
Organization Phone: 1 (714) 974-6316
Data has not been verified.