Sample Record for 2023-08-01-24
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993446 DEA: 120J34U4 EFIS: 1218000034
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-55,55-29.6,R6.4/10.3
Work Description: CONSTR BRIDGES, RW, SW, JPCP, HMA PVMT, DRAINAGE AND ELECT SYSTEMS.
Location Description: ORANGE COUNTY IN IRVINE, SANTA ANA, AND TUSTIN ON ROUTE 5 AT NEWPORT AVENUE UNDERCROSSING AND ON ROUTE 55 FROM 0.4 MILE NORTH OF ROUTE 55/405 SEPARATION TO 0.1 MILE SOUTH OF ROUTE 5/55 SEPARATION
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3075 Townsgate Road, Suite 200, Westlake Village, CA 91361
Resident Engineer: Adrian Wu Structure Rep.: Yong Gyun Park
Sample Information
DIME Sample ID: 2023-08-01-24
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: 08/01/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/01/2023
The quantity of what the sample constitutes: 30 CU.YDS
A brief description of the sample: PCC
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0741
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: National Ready Mix - IRVINE
Material Information
The concrete mix design number: S85C440T18
The truck number from where the sample was collected: 100971
The batch plant ticket number from where the sample was collected: 400399
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: CONVEYOR BELT
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
