Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215220 DEA: 07210624 EFIS: 0719000068
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA,SBD-71-1.8/R4.7&R0.0/R0.2
Work Description: PLACE STRUCTURE CONCRETE RETAINING WALLS & BOX CULVERT AND PLACE JPCP.
Location Description: IN LOS ANGELES AND SAN BERNARDINO COUNTIES IN POMONA AND CHINO HILLS FROM 0.2 MILE SOUTH OF MISSION BOULEVARD OVERCROSSING TO 0.2 MILE OF SAN BERNARDINO COUNTY LINE.
Contractor Name: OHL USA
Contractor Address: 1920 Main Street, Suite 310, Irvine, California 92614
Resident Engineer: Michael Wang Structure Rep.: Ryan Valentine
DIME Sample ID: 2024-12-23-17
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: 12/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/23/2024
The quantity of what the sample constitutes: 30 CY
A brief description of the sample: 6 x 12 LCB Cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 24-3975
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
The concrete mix design number: RRM22111
The truck number from where the sample was collected: Load 3 Truck 1341196
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled: Jobsite
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-12-23-17-1
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 12/27/2024
Date Tested: 12/23/2024
Submitted By Organization: Alta Vista Solutions - Whittier
Organization Address: 12409 Slauson Avenue, Suite I,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90606
Organization Email: nicholas.hoffmann@oneatlas.com
Organization Phone: (510) 542-9827
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2024-12-23-17-2
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Verified Date: 12/27/2024
Date Tested: 12/23/2024
Submitted By Organization: Alta Vista Solutions - Whittier
Organization Address: 12409 Slauson Avenue, Suite I,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90606
Organization Email: nicholas.hoffmann@oneatlas.com
Organization Phone: (510) 542-9827
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
