Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214697 DEA: 07307104 EFIS: 0714000213
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101-32.8
Work Description: CONSTRUCT BRIDGE.
Location Description: LOS ANGELES COUNTY IN AND NEAR AGOURA HILLS FROM 0.1 MILE WEST OF LIBERTY CANYON ROAD UNDERCROSSING TO 0.6 MILE EAST OF PALO COMADO OVERCROSSING
Contractor Name: CA Rasmussen
Contractor Address: 28548 LIVINGSTON AVENUE, VALENICA CA 91355
Resident Engineer: Sam Toutounchian Structure Rep.: Darwin Vargas
DIME Sample ID: 2024-03-22-27
TL Number from the TL Form:
Sample Submitted By Organization: Coreslab
Sample Organization Contact: (909) 936-7741
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 03/22/2024
Date that the sample was received by the laboratory/organization performing the testing: 03/22/2024
The quantity of what the sample constitutes: 27.4 CY
A brief description of the sample: 2251-1
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier: 53-3104
Structure name: Liberty Canyon Wildlife Over Crossing
The fabricator/manufacturer/facility name: Coreslab Structures L A Inc
The concrete mix design number: 2251-1
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 95847
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: from mix truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-03-22-27-1
Test Method: ASTM C39-21: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Submitted By Organization: Coreslab
Organization Address: 150 West Placentia Avenue,
Organization City: Perris
Organization State: CA
Organization Zipcode: 92571
Organization Email: bmalott@coreslab.com
Organization Phone: (909) 936-7741
Data has not been verified.
