Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993807 DEA: 07353304 EFIS: 0718000272
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-110-23.1
Work Description: REPLACE BRIDGE RAILING WITH CONCRETE BARRIER. AND UPGRADE LIGHTING.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES AT THIRD STREET OVERCROSSING
Contractor Name: POWELL CONSTRUCTORS INC
Contractor Address: 8555 BANANA AVE, FONTANA, CA 92335
Resident Engineer: Edgar Herrera Structure Rep.: Unknown
DIME Sample ID: 2023-09-29-40
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Department Acceptance
Type of Material: Polyester
Sample Taken Date: 09/29/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/29/2023
The quantity of what the sample constitutes: Unverifiable
A brief description of the sample: Relative Compaction of Polymer Concrete
From where was the sample collected: Job Site
Laboratory sample identification: 23-1508
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Powell Construcion
DIME Test ID: 2023-09-29-40-1
Test Method: CTM 552-December 2013: Method of Test for Relative Compaction of Polymer Concrete Utilizing Nuclear Gages
Verified Date: 10/11/2023
Date Tested: 09/29/2023
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 817-0387
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Gage No.
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63090
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Time of test
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01:05 HH:MM
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Standard Density
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2.23 g/cc
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In-Place Density
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2.18 g/cc
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Percent Relative Compaction
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98 %
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