Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214909 DEA: 120N8604 EFIS: 1214000123
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-73-23.7/24.1
Work Description: REPLACE STRUCTURAL CONCRETE BRIDGE & RETAINING WALL; & PLACE HMA.
Location Description: ORANGE COUNTY IN NEWPORT BEACH FROM 0.3 MILE NORTH OF BISON AVENUE TO 0.3 MILE SOUTH OF UNIVERSITY DRIVE
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 26320 LESTER CIRCLE, CORONA CA 92883
Resident Engineer: Jay Joubeen Structure Rep.: Ali Jenabzadeh
DIME Sample ID: 2021-04-06-58
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 04/06/2021
Date that the sample was received by the laboratory/organization performing the testing: 04/06/2021
The quantity of what the sample constitutes: 0-100 CY out of 152 CY
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: C040621-100
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex
The concrete mix design number: 1611682
The truck number from where the sample was collected: 10067277
The batch plant ticket number from where the sample was collected: 29566299
Concrete batch plant: Cemex Irvine
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: CIDH Piles
From Lot No.:
Bag Lot No.:
DIME Test ID: 2021-04-06-58-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: Sequoia Consultants
Organization Address: 361 West Grove Avenue,
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email: sranjan@sequoiacon.com
Organization Phone: 1 (714) 974-6316
Data has not been verified.
