Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214620 DEA: 07309304 EFIS: 0714000281
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-210,405,605-Various
Work Description: REINFORCE STRUCTURAL CONCRETE BRIDGE AND PLACE RHMA SHOULDER PAVING.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: Beador Const. Co. Inc.
Contractor Address: 26320 LESTER CIRCLE, CORONA CA 92883
Resident Engineer: MOHAMMAD IZADPANAH Structure Rep.: Richard Joludow
DIME Sample ID: 2021-11-23-4
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Department Acceptance
Type of Material: Aggregate
Sample Taken Date: 11/23/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/23/2021
The quantity of what the sample constitutes: 2200 SQFT
A brief description of the sample: Aggregate Base
From where was the sample collected: Job Site
Laboratory sample identification: 21-2832
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
Source Identification (SMARA, name of Pit or Job Site): NA
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: CTM 231 Test Holes
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2021-11-23-4-1
Test Method: CTM 216-June 2011: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 817-0387
Data has not been verified.
DIME Test ID: 2021-11-23-4-2
Test Method: CTM 231-March 2013: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates Using Nuclear Gages
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 817-0387
Data has not been verified.
