Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208869 DEA: 08368504 EFIS: 0800000628
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-177.3/181.1
Work Description: CONSTRUCT COMMERCIAL VEHICLE ENFORCEMENT FACILITY (CVEF)
Location Description: SAN BERNARDINO COUNTY FROM 1.2 MILES NORTH OF NIPTON ROAD OVERCROSSING TO 0.5 MILE SOUTH OF YATES WELL ROAD OVERCROSSING
Contractor Name: Las Vegas Paving Corporation
Contractor Address: 4420 S Decatur Blvd, Las Vegas, NV 89103
Resident Engineer: John Santos Structure Rep.: Lawrence Monsalud
DIME Sample ID: 2015-02-05-5
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 02/05/2015
Date that the sample was received by the laboratory/organization performing the testing: 02/05/2015
The quantity of what the sample constitutes: 4
A brief description of the sample: casting concrete beams
From where was the sample collected: Job Site
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: Jobsite
The concrete mix design number: P05AF814
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: 07
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: On Job Site at Concrete Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2015-02-05-5-1
Test Method: CTM 523-July 2012: Method of Test for Flexural Strength of Concrete
Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
Data has not been verified.
DIME Test ID: 2015-02-05-5-2
Test Method: CTM 523-July 2012: Method of Test for Flexural Strength of Concrete
Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
Data has not been verified.
DIME Test ID: 2015-02-05-5-3
Test Method: CTM 523-July 2012: Method of Test for Flexural Strength of Concrete
Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
Data has not been verified.
DIME Test ID: 2015-02-05-5-4
Test Method: CTM 523-July 2012: Method of Test for Flexural Strength of Concrete
Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
Data has not been verified.
