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: 2024-03-22-29
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: Fabricator
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: Coreslab Structures Incorporated
The fabricator/manufacturer designation for the sample: Batch
A detailed description of where the material sample was collected: Back of Truck
Where the material sample would have been placed if not sampled: in girder
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-03-22-29-1
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
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.
DIME Test ID: 2024-03-22-29-2
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
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.
DIME Test ID: 2024-03-22-29-3
Test Method: ASTM C1064-12: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
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.
DIME Test ID: 2024-03-22-29-4
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
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.
