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Sample Record for 2016-03-01-4

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 209217 DEA: 080F5404 EFIS: 0800000136 COOP: 081468 QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-91,15-0.0/13.04, 35.64/45.14
Work Description: SR-91 Corridor Improvement Project: Develop approx. 8 miles of tolled express lanes and related improvements within SR 91 between the Riverside/Orange County line and I-15, including transition areas.
Location Description: 08-RIV-91-0.0/13.04; 12-ORA-91-R14.43/R18.91; 08-RIV-15-35.64/45.14
Contractor Name: Atkinson Walsh, Joint Venture
Contractor Address: 1785 Sampson Ave, Corona, CA 92879
Resident Engineer: Richard Hebert Structure Rep.: Cyrus Shahinpar

Sample Information

DIME Sample ID: 2016-03-01-4
TL Number from the TL Form: SRL401
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 03/01/2016
Date that the sample was received by the laboratory/organization performing the testing: 03/06/2017
The quantity of what the sample constitutes: 6
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 888-SRL401
Structure unique identifier: NP
Structure name: Unknown
The fabricator/manufacturer/facility name: Holliday Rock Chino

Material Information

The concrete mix design number: CM5635
The truck number from where the sample was collected: NOT PROVIDED
The batch plant ticket number from where the sample was collected: NOT PROVIDED
Concrete batch plant: NP
The fabricator/manufacturer designation for the sample: NP
A detailed description of where the material sample was collected: LOAD 7
Where the material sample would have been placed if not sampled: BR 26 ABUT 18 APPROACH
From Lot No.: NP
Bag Lot No.: Unknown

Test Results