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Sample Record for 2019-05-08-12


Project Information

Project ID: 213750 DEA: 120K0224 EFIS: 1214000097 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-14.5/17.1
Work Description: South County Improvement Project (Phase 2 - Oso/Alicia) CONST BRIDGES, RW, SW, HMA PVMT, JPCP, DRAINAGE, AND ELECT SYSTEMS.
Location Description: ORANGE COUNTY IN MISSION VIEJO AND LAGUNA HILLS FROM 0.7 MILE SOUTH OF OSO PARKWAY OVERCROSSING TO 0.3 MILE SOUTH OF ALICIA PARKWAY OVERCROSSING
Contractor Name: FLATIRON WEST, INC Contractor Address: 1770 La Costa Meadows Drive
Resident Engineer: John Hong Structure Rep.: Kim, Young

Sample Information

DIME Sample ID: 2019-05-08-12
TL Number from the TL Form:
Sample Submitted By Organization: Cemex - Central & Southern California
Sample Organization Contact: (510)378-2044
Type of Sample: Annual Source Testing
Type of Material: Aggregate
Sample Taken Date: 05/08/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 of 2
A brief description of the sample: Washed Concrete Sand
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

Source Identification (SMARA or name of Pit): 91-36-0040::LYTLE CREEK
The fabricator's/manufacturer's product name for the sample: WCS
The fabricator/manufacturer designation for the sample:
The plant number: 4419
A detailed description of where the material sample was collected: Plant Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number:
Lot number:
Sublot number: