Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211260 DEA: 072159U4 EFIS: 0715000160
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA,ORA-5-0.0/1.5, 44.3/44.4
Work Description: CONSTRUCT HOV LANES AND MIX FLOW LANES.
Location Description: LOS ANGELES AND ORANGE COUNTIES IN BUENA PARK, LA MIRADA, CERRITOS AND SANTA FE SPRINGS FROM ARTESIA BOULEVARD UNDERCROSSING TO NORTH FORK COYOTE CREEK
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3075 TOWNSGATE RD. SUITE 200, WESTLAKE VILLAGE, CA 91361
Resident Engineer: George Saker Structure Rep.: Danny Lalonde
DIME Sample ID: 2022-04-21-15
TL Number from the TL Form:
Sample Submitted By Organization: Kleinfelder, Incorporated - Los Angeles
Sample Organization Contact: (909) 833-5780
Type of Sample: Quality Assurance
Type of Material: Soil
Sample Taken Date: 04/21/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/22/2022
The quantity of what the sample constitutes: 1500 CY
A brief description of the sample: A set of 2 JPCP concrete beam test specimens
From where was the sample collected: Job Site
Laboratory sample identification: 22-0895
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: SECURITY PAVING PORTABLE PLANT- LA MIRADA
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
