Sample Record for 2014-04-10-22003895
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 3811 DEA: 071219U4 EFIS: 0700001829
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5,170-58.0/63.4,R32.3/R33.1
Work Description: Construct HOV lanes, connectors and replace slabs.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES ON ROUTE 5 FROM 0.1 KM NORTH OF SHELDON STREET OVERCROSSING TO ROUTE 5/118 SEPARATION AND ON ROUTE 170 FROM 0.1 KM SOUTH OF ARLETA/SHELDON UNDERCROSSING TO ROUTE 5/170 SEPARATION
Contractor Name: FLATIRON WEST INC
Contractor Address: 9215 Cranford Ave, Pacoima, CA 91331
Resident Engineer: Emile Eid Structure Rep.: Hooshang Alishahi
Sample Information
DIME Sample ID: 2014-04-10-22003895
TL Number from the TL Form:
Sample Submitted By Organization: ZZEX DIME Development - AVS Testing External
Sample Organization Contact:
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 04/10/2014
Date that the sample was received by the laboratory/organization performing the testing: 04/11/2014
The quantity of what the sample constitutes: 3 beams
A brief description of the sample: PCC
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan
Material Information
The concrete mix design number: S10
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 1100
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Job site
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
