Sample Record for 2022-04-24-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215370 DEA: 11427504 EFIS: 1116000177
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD,IMP-5,7,111,186,188etc-VAR
Work Description: INSTALL FIBER OPTIC CABLE AND POINT VEHICLE DETECTION FIELD ELEMENTS.
Location Description: SAN DIEGO AND IMPERIAL COUNTIES AT VARIOUS LOCATIONS
Contractor Name: HMS Construction Inc. (Att: Jeff Summer)
Contractor Address: 1047 La Mirada Court, Vista CA 92081
Resident Engineer: Victor Cardenas Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2022-04-24-2
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 518-8709
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 04/24/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/25/2022
The quantity of what the sample constitutes: 12 boxes, 2 bags, 4 cans
A brief description of the sample: 1/2" JMF Renewal
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Otay
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-37-0035
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: Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
