Sample Record for 2022-01-26-20
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214620 DEA: 07309304 EFIS: 0714000281
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-210,405,605-Various
Work Description: REINFORCE STRUCTURAL CONCRETE BRIDGE AND PLACE RHMA SHOULDER PAVING.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: Beador Const. Co. Inc.
Contractor Address: 26320 LESTER CIRCLE, CORONA CA 92883
Resident Engineer: MOHAMMAD IZADPANAH Structure Rep.: Richard Joludow
Sample Information
DIME Sample ID: 2022-01-26-20
TL Number from the TL Form: C-0126A1
Sample Submitted By Organization: CT D07 - Plant Services
Sample Organization Contact: 562-345-3126
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 01/26/2022
Date that the sample was received by the laboratory/organization performing the testing: 02/02/2022
The quantity of what the sample constitutes: 50 CY
A brief description of the sample: 1x4 pcc aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-36-0106::WHITE MOUNTAIN QUARRY
The fabricator's/manufacturer's product name for the sample: PCC mix
The fabricator/manufacturer designation for the sample: mix 1612109
The plant number: Los Angeles
A detailed description of where the material sample was collected: Plant Stockpile
Where the material sample would have been placed if not sampled: barrier
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: 1612109
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
