Sample Record for 2021-12-08-31
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214355 DEA: 120K0214 EFIS: 1214000096
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-12.4/14.5
Work Description: South County Improvement Project (Phase 1 - Avery/Crown Valley) PLACE HMA, INSTALL CONC PAVEMENT, RETAIN WALL, MODIFY ELECT SYS. | Add one lane btwn 73 & Oso PKWY
Location Description: ORANGE COUNTY IN SAN JUAN CAPISTRANO, LAGUNA HILLS, LAGUNA NIGUEL AND MISSION VIEJO FROM 0.5 MILE SOUTH OF AVERY PARKWAY UNDERCROSSING TO 0.8 MILE NORTH OF CROWN VALLEY PARKWAY OVERCROSSING
Contractor Name: ORTIZ ENTERPRISES, INC.
Contractor Address: 6 Cushing, Suite 200, Irvine, CA 92618
Resident Engineer: Kifah Ramadan Structure Rep.: Imad Karam
Sample Information
DIME Sample ID: 2021-12-08-31
TL Number from the TL Form:
Sample Submitted By Organization: Coreslab
Sample Organization Contact: (909) 936-7741
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 12/08/2021
Date that the sample was received by the laboratory/organization performing the testing: 12/09/2021
The quantity of what the sample constitutes: 28.8
A brief description of the sample: 6x12 Cylinders
From where was the sample collected: Fabricator
Laboratory sample identification: 429
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Coreslab Structures L A Inc
Material Information
The concrete mix design number: 212
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 82020-82021
Concrete batch plant:
The fabricator/manufacturer designation for the sample: 504
A detailed description of where the material sample was collected: Bed 9 from front discharge RMT into wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
Test 1 of 1
DIME Test ID: 2021-12-08-31-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 02/08/2022
Date Tested: 12/08/2021
Submitted By Organization: Coreslab
Organization Address: 150 West Placentia Avenue,
Organization City: Perris
Organization State: CA
Organization Zipcode: 92571
Organization Email: bmalott@coreslab.com
Organization Phone: (909) 936-7741
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
