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Sample Record for 2021-04-12-24

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

Project Information

Project ID: 214938 DEA: 120M9904 EFIS: 1213000086 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-1-9.4
Work Description: Replace Precast RCB Culvert & Sewer Pipe & Place HMA Pavement
Location Description: ORANGE COUNTY IN LAGUNA BEACH AT BROADWAY STREET
Contractor Name: GRIFFITH COMPANY
Contractor Address: 3050 E. BIRCH STREET, BREA, CA 92821
Resident Engineer: Mohamad Yacoub Structure Rep.: Imad Karam

Sample Information

DIME Sample ID: 2021-04-12-24
TL Number from the TL Form:
Sample Submitted By Organization: Structure Cast
Sample Organization Contact: (661) 301-2624
Type of Sample: Informational
Type of Material: Concrete
Sample Taken Date: 04/12/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 9.5 CY
A brief description of the sample: SCC Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: StructureCast

Material Information

The concrete mix design number: 12-0M9904
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 3233
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

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.