Sample Record for 2022-06-12-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214493 DEA: 07311704 EFIS: 0715000013
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-134-0.0/R13.3
Work Description: CONCRETE SLAB REPLACEMENT, HMA PAVING, ELECTRICAL AND LANDSCAPE WORK.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES, BURBANK, GLENDALE AND PASADENA FROM ROUTE 101/134 SEPARATION TO JUNCTION OF ROUTE 210/710
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606-4414
Resident Engineer: David Ayala Vanegas Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2022-06-12-2
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: Concrete
Sample Taken Date: 06/12/2022
Date that the sample was received by the laboratory/organization performing the testing: 06/12/2022
The quantity of what the sample constitutes: 200 CY
A brief description of the sample: A set of 3 ISR-RSC Beams
From where was the sample collected: Job Site
Laboratory sample identification: 22-1414
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Not Provided
Material Information
The concrete mix design number: 2010-007
The truck number from where the sample was collected: 111
The batch plant ticket number from where the sample was collected: Load 1
Concrete batch plant:
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:
From Lot No.:
Bag Lot No.:
Test Results
