Sample Record for 2019-04-04-14
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 210735 DEA: 071193U4 EFIS: 0713000007
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-37.2/42.4
Work Description: CONSTRUCT HOV LANES, WIDEN BRIDGES, AND REALIGN RAMPS.
Location Description: IN LA COUNTY FROM CITRUS STREET IN WEST COVINA TO ROUTE 57 IN POMONA
Contractor Name: Guy F. Atkinson
Contractor Address: 18201 Von Karman Ave, Suite #800, IRVINE CA 92612
Resident Engineer: Rodolfo Cao Structure Rep.: David Win
Sample Information
DIME Sample ID: 2019-04-04-14
TL Number from the TL Form:
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Annual Source Testing
Type of Material: Concrete
Sample Taken Date: 04/04/2019
Date that the sample was received by the laboratory/organization performing the testing: 04/08/2019
The quantity of what the sample constitutes: 5 Bags
A brief description of the sample: 1.0" PCC Aggregates
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: 91-36-0006
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: 703414
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
Test Results
Tests Assigned to this Sample
| DIME Test ID | Test Method | Assigned Date | Test Date | Assigned By | Assigned Lab | Test Comments | Assigned To |
| No tests have been assigned to this sample. |