Sample Record for 2015-10-12-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 7613 DEA: 071218W4 EFIS: 0700021119
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-29.4/31.6
Work Description: REALIGN ROUTE 5 AND RAILROAD TRACKS AND RECONFIGURE ON- AND OFF-RAMPS.
Location Description: LOS ANGELES COUNTY IN BURBANK FROM WEST MAGNOLIA BOULEVARD OVERCROSSING TO 0.3 MILE NORTH OF BUENA VISTA STREET/WINONA AVENUE UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Vladimir Gurfinkel Structure Rep.: Gon Choi
Sample Information
DIME Sample ID: 2015-10-12-3
TL Number from the TL Form: 1012
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 10/12/2015
Date that the sample was received by the laboratory/organization performing the testing: 10/15/2015
The quantity of what the sample constitutes: 2
A brief description of the sample: 6x12
From where was the sample collected: Job Site
Laboratory sample identification: 889-12
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: National Ready Mix
Material Information
The concrete mix design number: s62578
The truck number from where the sample was collected: 475
The batch plant ticket number from where the sample was collected: 186833
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Unknown
Where the material sample would have been placed if not sampled: Unknown
From Lot No.:
Bag Lot No.:
Test Results
