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Sample Record for 2021-09-24-47

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

Project Information

Project ID: 212112 DEA: 080C2514 EFIS: 0816000076 COOP: 081645 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-0.0/13.2
Work Description: Design-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes
Location Description: LA/SBD County Line to PM 13.2 near I-15
Contractor Name: Lane-Security Paving Joint Venture
Contractor Address: 3450 Centre Lake Drive, 1st Floor, Ontario, CA 91761
Resident Engineer: Matt Antonelli Structure Rep.: Faisal Zahlout

Sample Information

DIME Sample ID: 2021-09-24-47
TL Number from the TL Form: 1015-924
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/24/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/15/2021
The quantity of what the sample constitutes: 4
A brief description of the sample: 6x12
From where was the sample collected: Job Site
Laboratory sample identification: 1015-924
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: np

Material Information

The concrete mix design number: 1610974
The truck number from where the sample was collected: 1007485
The batch plant ticket number from where the sample was collected: not provided
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: job
Where the material sample would have been placed if not sampled: abutment 2 approach slabs
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.