Sample Record for 2020-09-25-28
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 209141 DEA: 07215954 EFIS: 0700001835
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-0.0/7.6
Work Description: WIDENING FREEWAY AND RECONSTRUCT OVERHEAD AND OVERCROSSING STRUCTURES
Location Description: LOS ANGELES COUNTY IN LA MIRADA, SANTA FE SPRINGS, NORWALK AND DOWNEY FROM ORANGE COUNTY/LOS ANGELES COUNTY LIMIT LINES TO 0.7 MILE NORTH OF ROUTE 605
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Thang Ton Structure Rep.: Amare Tsagie
Sample Information
DIME Sample ID: 2020-09-25-28
TL Number from the TL Form: Unknown
Sample Submitted By Organization: G3 Quality, Incorporated - Cerritos
Sample Organization Contact: (562) 321-9840
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 09/25/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/26/2020
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: rock and sand
From where was the sample collected: Source
Laboratory sample identification: Mix G3-15-590-3600
Structure unique identifier: 00-0000
Structure name:
The fabricator/manufacturer/facility name: Security Paving - Florance
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-19-0025::IRWINDALE
The fabricator's/manufacturer's product name for the sample: set 1
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Batch Plant
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: G3-15-590-3600
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:
Test Results
