Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994582 DEA: 073203U4 EFIS: 0722000071
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-91,605-R16.6/R16.8,R0.0/R10.4
Work Description: PLACE CONCRETE PAVEMENT AND HIGH FRICTION SURFACE TREATMENT.
Location Description: LOS ANGELES COUNTY ON ROUTE 605 FROM 0.2 MILE NORTH OF KATELLA AVENUE UNDECROSSING TO 0.1 MILE NORTH OF TELEGRAPH ROAD UNDERCROSSING AND ON ROUTE 91 FROM 0.4 MILE WEST OF ROUTE 605 UNDERCROSSING TO 0.2 MILE WEST OF ROUTE 605 UNDERCROSSING
Contractor Name: RASMUSSEN/VANGUARD
Contractor Address: 28548 LIVINGSTON AVENUE, VALENCIA CA 91335
Resident Engineer: Martin Oregel Structure Rep.: Tien Chu
DIME Sample ID: 2024-07-12-104
TL Number from the TL Form:
Sample Submitted By Organization: Alta Vista Solutions - Whittier
Sample Organization Contact: (510) 542-9827
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 07/12/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/12/2024
The quantity of what the sample constitutes: 10 cubic yards
A brief description of the sample: A set of 3 JPCP RSC beams
From where was the sample collected: Job Site
Laboratory sample identification: 24-2500
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: N/A
The concrete mix design number: CTS-65EHI
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 2
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
