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Sample Record for 2021-08-13-4

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

Project Information

Project ID: 208973 DEA: 120H1004 EFIS: 1200000180 COOP: 120670 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-405,73,405,605-9.3/24.3
Work Description: (Alternative Delivery) San Diego Freeway (I-405) Improvement Project SR-73 to I-605, Design Build Project, Administered by Orange County Transportation Authority, Caltrans METS to perform Source Inspection per RFP.
Location Description: Orange and Los Angeles Counties: 12-ORA-405 PM 9.3/24.2 / 07-LA-405 PM 0.0/1.2 12-ORA-22 PM R0.7/R3.8 / 12-ORA-22 PM R0.5/R0.7 12-ORA-73 PM R27.2/R27.8 / 12-ORA-605 PM 3.5/R1.6 07-LA-605 PM R0.0/R1.2
Contractor Name: OC 405 Partners
Contractor Address: 3100 W Lake Center Dr, Santa Ana, CA 92704
Resident Engineer: Hank Alonso (reports) Structure Rep.: Cal Zachman (reports)

Sample Information

DIME Sample ID: 2021-08-13-4
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Los Angeles Field Laboratory
Sample Organization Contact: (858) 285-5797
Type of Sample: Verification
Type of Material: Cementitious
Sample Taken Date: 08/13/2021
Date that the sample was received by the laboratory/organization performing the testing: 08/16/2021
The quantity of what the sample constitutes: 2
A brief description of the sample: RW 662 LCC Cement Type II/V
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex

Material Information

Brand: Cemex
Mill: Victorville
Type of Cementitious Material: Type II/V Cement

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.