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Sample Record for 2019-06-15-3

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

Project Information

Project ID: 212888 DEA: 07202124 EFIS: 0700020870 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-710-20.9/24.6
Work Description: PAVEMENT REHABILITATION AND BRIDGE WIDENING
Location Description: LOS ANGELES COUNTY IN AND NEAR BELL, VERNON, AND CITY OF COMMERCE, FROM 0.2 MILE SOUTH OF SLAUSON AVENUE OVERCROSSING TO 0.1 MILE NORTH OF THIRD STREET OVERCROSSING
Contractor Name: FLATIRON WEST, INC.
Contractor Address: 15335 Fairfield Ranch Road, Suite 200, Chino Hills, CA 91709
Resident Engineer: Peter Lee Structure Rep.: James Holloway

Sample Information

DIME Sample ID: 2019-06-15-3
TL Number from the TL Form:
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Per Request
Type of Material: Aggregate
Sample Taken Date: 06/15/2019
Date that the sample was received by the laboratory/organization performing the testing: 06/17/2019
The quantity of what the sample constitutes: 4 Bags
A brief description of the sample: Class 3 Agg Base
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Caltrans

Material Information

Source Identification (SMARA or name of Pit): Unknown
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: SR 710
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.