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Sample Record for 2020-03-16-9

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

Project Information

Project ID: 214355 DEA: 120K0214 EFIS: 1214000096 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-12.4/14.5
Work Description: South County Improvement Project (Phase 1 - Avery/Crown Valley) PLACE HMA, INSTALL CONC PAVEMENT, RETAIN WALL, MODIFY ELECT SYS. | Add one lane btwn 73 & Oso PKWY
Location Description: ORANGE COUNTY IN SAN JUAN CAPISTRANO, LAGUNA HILLS, LAGUNA NIGUEL AND MISSION VIEJO FROM 0.5 MILE SOUTH OF AVERY PARKWAY UNDERCROSSING TO 0.8 MILE NORTH OF CROWN VALLEY PARKWAY OVERCROSSING
Contractor Name: ORTIZ ENTERPRISES, INC.
Contractor Address: 6 Cushing, Suite 200, Irvine, CA 92618
Resident Engineer: Kifah Ramadan Structure Rep.: Imad Karam

Sample Information

DIME Sample ID: 2020-03-16-9
TL Number from the TL Form:
Sample Submitted By Organization: SCST, LLC
Sample Organization Contact: (619) 280-4321
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 03/16/2020
Date that the sample was received by the laboratory/organization performing the testing: 03/16/2020
The quantity of what the sample constitutes: Annual Source Testing
A brief description of the sample: WCS
From where was the sample collected: Manufacturer
Laboratory sample identification: 52450
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Redlands

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-36-0068::REDLANDS WASH PLAN (CEMEX)
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: Stockpile
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: fine
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:

Test Results