Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214920 DEA: 073W8704 EFIS: 0717000118
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1-46.9/50.4
Work Description: PERFORM SLURRY SEAL, REPLACE AC SURFACING AND INDIVIDUAL SLABS.
Location Description: LOS ANGELES COUNTY IN AND NEAR MALIBU FROM MALIBU LAGOON BRIDGE TO SOLISTICE CANYON CREEK BRIDGE
Contractor Name: DREAMBUILDER CONSTRUCTION CORP DBA DREAMBUILDER
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2021-11-05-14
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 11/05/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/05/2021
The quantity of what the sample constitutes: 7.38 CY
A brief description of the sample: Trial batch at contractor's yard
From where was the sample collected: Manufacturer
Laboratory sample identification: 21-2698
Structure unique identifier: 21-2698
Structure name: Trial Slab
The fabricator/manufacturer/facility name: Dreambuilders
The concrete mix design number: CTS-65-EHI
The truck number from where the sample was collected: 15
The batch plant ticket number from where the sample was collected: 15
Concrete batch plant: Short load concrete
The fabricator/manufacturer designation for the sample: Dreambuilders
A detailed description of where the material sample was collected: 500 Porter Way Placentia CA 92870
Where the material sample would have been placed if not sampled: Job site
From Lot No.: 1
Bag Lot No.: 1
DIME Test ID: 2021-11-05-14-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 817-0387
Data has not been verified.
