Sample Record for 2021-04-22-36
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214663 DEA: 081F7304 EFIS: 0815000034
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-215-2.7
Work Description: REPLACE CONCRETE BRIDGE, PLACE CONCRETE PCPS GIRDERS AND HMA.
Location Description: SAN BERNARDINO COUNTY IN COLTON AT WASHINGTON STREET OVERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVE, SYLMAR, CA, 91342
Resident Engineer: Shaine Shahidi Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2021-04-22-36
TL Number from the TL Form: 3913
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Annual Source Testing
Type of Material: Aggregate
Sample Taken Date: 04/22/2021
Date that the sample was received by the laboratory/organization performing the testing: 04/22/2021
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: Washed Concrete Sand
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex-Moorpark Quarry
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-56-0014::MOORPARK
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: Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
