Sample Record for 2022-02-02-36
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215164 DEA: 07317304 EFIS: 0715000237
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-60-0.0/R3.2,11.8/R21.5
Work Description: UPGRADE EXISTING OVERHEAD AND ROADSIDE SIGN PANELS.
Location Description: LOS ANGELS COUNTY FROM 0.4 MILE WEST OF ROUTE 5/60 SEPARATION TO ROUTE 60/710 SEPARATION AND FROM ROUTE 60/605 SEPARATION TO FAIRWAY DRIVE UNDERCROSSING
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 CONSTRUCTION CIRCLE WEST, IRVINE CA 92606
Resident Engineer: Myrna Dominguez Structure Rep.: Avtar Bains
Sample Information
DIME Sample ID: 2022-02-02-36
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Plant Services
Sample Organization Contact: 562-345-3126
Type of Sample: Department Acceptance
Type of Material: Aggregate
Sample Taken Date: 02/02/2022
Date that the sample was received by the laboratory/organization performing the testing: 02/02/2022
The quantity of what the sample constitutes: Three Bags
A brief description of the sample: Coarse and fine aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Associate Ready Mix - LA
Material Information
Source Identification (SMARA, name of Pit or Job Site): Hanson Irvine
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: Conveyor Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: SL590330
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
