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

Sample Record for 2020-05-29-33


Project Information

Project ID: 213764 DEA: 080F0304 EFIS: 0800020358 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-60-R0.7/R3.0
Work Description: REMOVE AND REPLACE THREE OVERCROSSING BRIDGES ON ROUTE 60
Location Description: IN SAN BERNARDINO COUNTY IN AND NEAR CHINO AT VARIOUS LOCATIONS FROM O.1 MILE WEST OF PIPELINE AVENUE OVERCROSSING TO 0.1 MILE EAST OF BENSON AVENUE OVERCROSSING
Contractor Name: SEMA CONSTRUCTION, INC. Contractor Address: 42690 Rio Nedo, Suite G
Resident Engineer: Miguel Calixto Structure Rep.: Kim, Richard

Sample Information

DIME Sample ID: 2020-05-29-33
TL Number from the TL Form: 5293
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/29/2020
Date that the sample was received by the laboratory/organization performing the testing: 06/03/2020
The quantity of what the sample constitutes: NA
A brief description of the sample: CONCRETE CYLINDERS
From where was the sample collected: Job Site
Laboratory sample identification: 1003-5293
Structure unique identifier:
Structure name:

Material Information

The concrete mix design number: RRM18161
The truck number from where the sample was collected: 1616
The batch plant ticket number from where the sample was collected: LOAD 23
Concrete batch plant: ROBERTONS
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: NA
Where the material sample would have been placed if not sampled: STAGE 1 PIPELINE AVE OC ABUTMENT 3 STEM
From Lot No.: Unknown
Bag Lot No.: Unknown