Sample Record for 2021-10-19-32
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214524 DEA: 07304504 EFIS: 0714000067
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-57-R0.0/R4.5
Work Description: CONCRETE PAVEMENT, CONCRETE BARRIER, AND ELECTRICAL WORK.
Location Description: LOS ANGELES COUNTY IN DIAMOND BAR AND CITY OF INDUSTRY FROM ORANGE COUNTY LINE TO ROUTE 57/60 SEPARATION
Contractor Name: Griffith Company
Contractor Address: 3050 E. Birch Street, Brea, CA 92821
Resident Engineer: Martin Sandoval Structure Rep.: Avtar Bains
Sample Information
DIME Sample ID: 2021-10-19-32
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Verification
Type of Material: Concrete
Sample Taken Date: 10/19/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/16/2021
The quantity of what the sample constitutes: Per 1000 CY
A brief description of the sample: A set of 2 PCC concrete beam test specimens
From where was the sample collected: Job Site
Laboratory sample identification: 212640-07304504-111621
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vanguard at the 57 Freeway
Material Information
The concrete mix design number: crcp 570
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 8421
Concrete batch plant: Vanguard at 57 Freeway
The fabricator/manufacturer designation for the sample: Batch
A detailed description of where the material sample was collected: concrete sample from wheelbarrow
Where the material sample would have been placed if not sampled: NB 57 mainline
From Lot No.:
Bag Lot No.:
Test Results
