Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 7613 DEA: 071218W4 EFIS: 0700021119
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-29.4/31.6
Work Description: REALIGN ROUTE 5 AND RAILROAD TRACKS AND RECONFIGURE ON- AND OFF-RAMPS.
Location Description: LOS ANGELES COUNTY IN BURBANK FROM WEST MAGNOLIA BOULEVARD OVERCROSSING TO 0.3 MILE NORTH OF BUENA VISTA STREET/WINONA AVENUE UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Vladimir Gurfinkel Structure Rep.: Gon Choi
DIME Sample ID: 2021-11-13-11
TL Number from the TL Form: 21-2795
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: 11/13/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/13/2021
The quantity of what the sample constitutes: 300 cy
A brief description of the sample: Burbank blvd
From where was the sample collected: Job Site
Laboratory sample identification: 21-2795
Structure unique identifier: 21-2795
Structure name: Sopheak Chong
The fabricator/manufacturer/facility name: Security Paving
The concrete mix design number: Security Paving
The truck number from where the sample was collected: 3
The batch plant ticket number from where the sample was collected: 225645
Concrete batch plant: Security Paving batch plant
The fabricator/manufacturer designation for the sample: Security Paving
A detailed description of where the material sample was collected: Burbank Blvd
Where the material sample would have been placed if not sampled: Jobsite
From Lot No.:
Bag Lot No.:
DIME Test ID: 2021-11-13-11-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
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.
