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: 2023-08-01-107
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Visalia Field Laboratory
Sample Organization Contact: (559) 341-4165
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: 08/02/2023
The quantity of what the sample constitutes: 9.5 CY
A brief description of the sample: type II/V Concrete Cement
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: 06-Tul 99 J St -Ave 264
The fabricator/manufacturer/facility name: Calport Tul
The concrete mix design number: 63241NOP
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: Unknown
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Job site
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-08-01-107-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: CT D06 - Visalia Field Laboratory
Organization Address: 8530 West Roosevelt Avenue,
Organization City: Visalia
Organization State: CA
Organization Zipcode: 93291
Organization Email: shoaib.ahmed@dot.ca.gov
Organization Phone: (559) 341-4165
Data has not been verified.
