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Sample Record for 2021-11-29-19

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

Project Information

Project ID: 214524 DEA: 07304504 EFIS: 0714000067 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-57-R0.0/R4.5
Work Description: CONCRETE PAVEMENT, CONCRETE BARRIER, AND ELECTRICAL WORK.
Location Description: LOS ANGELES COUNTY IN DIAMOND BAR AND CITY OF INDUSTRY FROM ORANGE COUNTY LINE TO ROUTE 57/60 SEPARATION
Contractor Name: Griffith Company
Contractor Address: 3050 E. Birch Street, Brea, CA 92821
Resident Engineer: Martin Sandoval Structure Rep.: Avtar Bains

Sample Information

DIME Sample ID: 2021-11-29-19
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: 11/29/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/30/2021
The quantity of what the sample constitutes: 250 CY
A brief description of the sample: ISR-RSC
From where was the sample collected: Job Site
Laboratory sample identification: 21-2865
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vanguard Batch Plant at CA-57

Material Information

The concrete mix design number: HE4X4BM
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant: Vanguard at 57 Freeway
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Discharge from concrete truck into wheelbarrow.
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 3

DIME Test ID: 2021-11-29-19-1
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 3

DIME Test ID: 2021-11-29-19-2
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.

Test 3 of 3

DIME Test ID: 2021-11-29-19-3
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength 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.