Sample Record for 2022-01-20-36
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214573 DEA: 073096U4 EFIS: 0719000091
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-210-R0.0/R9.7
Work Description: PLACE CONCRETE PAVEMENT, BARRIER, HMA, DRAINAGE, AND ELECTRICAL.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES FROM INTERSTATE 5 TO WHEATLAND AVENUE UNDERCROSSING
Contractor Name: FLATIRON WEST INC
Contractor Address: 15335 FAIRFIELD RANCH ROAD, CHINO HILLS, CA 91709
Resident Engineer: Ridwan Salman Structure Rep.: Adriana Pimienta
Sample Information
DIME Sample ID: 2022-01-20-36
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Plant Services
Sample Organization Contact: 562-345-3126
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 01/20/2022
Date that the sample was received by the laboratory/organization performing the testing: 01/21/2022
The quantity of what the sample constitutes: 100 CY
A brief description of the sample: PCC Aggregate
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Flatiron Plant - Paxton off-Ramp
Material Information
Source Identification (SMARA, name of Pit or Job Site): Vulcan, Durbin
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Conveyor Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number: JPCP-3215-06
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
