Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212910 DEA: 080K2914 EFIS: 0812000098
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-30.9/33.3
Work Description: LANE REPLACEMENT
Location Description: SAN BERNARDINO COUNTY IN REDLANDS FROM ORANGE STREET UNDERCROSSING TO REDLANDS BLVD OFF-RAMP UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Nick Truong Structure Rep.: Ali El-Zaynab
DIME Sample ID: 2019-01-18-3
TL Number from the TL Form:
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: 5625005861
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 01/18/2019
Date that the sample was received by the laboratory/organization performing the testing: 01/19/2019
The quantity of what the sample constitutes: 1
A brief description of the sample: Rapid Strength Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: Cemex Redlands
The concrete mix design number: 1555211
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: from mix truck
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
DIME Test ID: 2019-01-18-3-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Submitted By Organization: CT - Unassigned/General Field Laboratory
Organization Address: 5900 Folsom Boulevard, MS 5,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brett.soldano@dot.ca.gov
Organization Phone: (562) 500-5861
Data has not been verified.