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Sample Record for 2019-02-13-11

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

Project Information

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

Sample Information

DIME Sample ID: 2019-02-13-11
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 02/13/2019
Date that the sample was received by the laboratory/organization performing the testing: 02/13/2019
The quantity of what the sample constitutes: 3
A brief description of the sample: Concrete beams
From where was the sample collected: Job Site
Laboratory sample identification: 29RA, 29RB, 29RC
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: Cemex Redlands

Material Information

The concrete mix design number: Unknown
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: Unknown
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Unknown
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown

Test Results