Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215425 DEA: 06360244 EFIS: 0613000005
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-30.6/35.2
Work Description: Widen Freeway & Bridge Construction (Concrete Bridge)
Location Description:
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVE, SYLMAR, CA, 91342
Resident Engineer: Javier Huerta Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2023-08-11-76
TL Number from the TL Form:
Sample Submitted By Organization: G3 Quality, Incorporated - Cerritos
Sample Organization Contact: (562) 321-9840
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/11/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/12/2023
The quantity of what the sample constitutes: 7
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: Set 1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Job Site
The concrete mix design number: 63241N0P
The truck number from where the sample was collected: Load 3
The batch plant ticket number from where the sample was collected: 0
Concrete batch plant:
The fabricator/manufacturer designation for the sample: Set 1
A detailed description of where the material sample was collected: J St. Bridge by Embankment 1 Barrier Wall
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-08-11-76-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
Data has not been verified.
DIME Test ID: 2023-08-11-76-2
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
Data has not been verified.
