Sample Record for 2023-07-19-19
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214355 DEA: 120K0214 EFIS: 1214000096
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-12.4/14.5
Work Description: South County Improvement Project (Phase 1 - Avery/Crown Valley) PLACE HMA, INSTALL CONC PAVEMENT, RETAIN WALL, MODIFY ELECT SYS. | Add one lane btwn 73 & Oso PKWY
Location Description: ORANGE COUNTY IN SAN JUAN CAPISTRANO, LAGUNA HILLS, LAGUNA NIGUEL AND MISSION VIEJO FROM 0.5 MILE SOUTH OF AVERY PARKWAY UNDERCROSSING TO 0.8 MILE NORTH OF CROWN VALLEY PARKWAY OVERCROSSING
Contractor Name: ORTIZ ENTERPRISES, INC.
Contractor Address: 6 Cushing, Suite 200, Irvine, CA 92618
Resident Engineer: Artin Merati Structure Rep.: Imad Karam
Sample Information
DIME Sample ID: 2023-07-19-19
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 07/19/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/19/2023
The quantity of what the sample constitutes: 432 Cubic Yard
A brief description of the sample: JPCP
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0682
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Irvine
Material Information
The concrete mix design number: 1605762
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 41974765
Concrete batch plant: Cemex Irvine
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: At the Cemex Plant
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
