Sample Record for 2019-07-27-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213746 DEA: 080Q75U4 EFIS: 0817000114
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD,RIV-60-R4.6/R9.9, R0.0/12.2
Work Description: REPLACEMENT OF TWO OUTSIDE LANES AND CONCRETE SLABS
Location Description:
Contractor Name: J McLoughlin Engineering
Contractor Address: 10641 Fulton Court, Rancho Cucamonga, CA 91730
Resident Engineer: Mujahid Qureshi Structure Rep.: Ching Chuang
Sample Information
DIME Sample ID: 2019-07-27-2
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 07/27/2019
Date that the sample was received by the laboratory/organization performing the testing: 07/27/2019
The quantity of what the sample constitutes: 3 bags
A brief description of the sample: 1x 4 Pcc Aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RV Concrete Inc
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0027::CORONA QUARRY
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: belt cut
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:
Test Results
