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Sample Record for 2021-11-24-19

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

Project Information

Project ID: 211260 DEA: 072159U4 EFIS: 0715000160 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA,ORA-5-0.0/1.5, 44.3/44.4
Work Description: CONSTRUCT HOV LANES AND MIX FLOW LANES.
Location Description: LOS ANGELES AND ORANGE COUNTIES IN BUENA PARK, LA MIRADA, CERRITOS AND SANTA FE SPRINGS FROM ARTESIA BOULEVARD UNDERCROSSING TO NORTH FORK COYOTE CREEK
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3075 TOWNSGATE RD. SUITE 200, WESTLAKE VILLAGE, CA 91361
Resident Engineer: George Saker Structure Rep.: Danny Lalonde

Sample Information

DIME Sample ID: 2021-11-24-19
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Material Lab, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 11/24/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/25/2021
The quantity of what the sample constitutes: 40CY
A brief description of the sample: 6x12 LCB cylinders
From where was the sample collected: Source
Laboratory sample identification: 21-2847
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Security Paving batch plant

Material Information

The concrete mix design number: G317LCB004
The truck number from where the sample was collected: 4
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant: Security Batch Plant
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Loader
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 4

DIME Test ID: 2021-11-24-19-1
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Submitted By Organization: CT D07 - Material Lab, Unit 1953
Organization Address: 1940 S. Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email:
Organization Phone: (213) 817-0387
Data has not been verified.

Test 2 of 4

DIME Test ID: 2021-11-24-19-3
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: CT D07 - Material Lab, Unit 1953
Organization Address: 1940 S. Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email:
Organization Phone: (213) 817-0387
Data has not been verified.

Test 3 of 4

DIME Test ID: 2021-11-24-19-4
Test Method: CTM 533-June 2010: Method of Test for Ball Penetration in Fresh Portland Cement Concrete
Submitted By Organization: CT D07 - Material Lab, Unit 1953
Organization Address: 1940 S. Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email:
Organization Phone: (213) 817-0387
Data has not been verified.

Test 4 of 4

DIME Test ID: 2021-11-24-19-5
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Submitted By Organization: CT D07 - Material Lab, Unit 1953
Organization Address: 1940 S. Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email:
Organization Phone: (213) 817-0387
Data has not been verified.

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.