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Sample Record for 2022-01-06-55

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: 2022-01-06-55
TL Number from the TL Form: 5554
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: 01/06/2022
Date that the sample was received by the laboratory/organization performing the testing: 01/06/2022
The quantity of what the sample constitutes: 250
A brief description of the sample: 1 x 4 PCC Aggregate
From where was the sample collected: Fabricator
Laboratory sample identification: C-924023
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Flat Iron

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-19-0023::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: stock pile
Where the material sample would have been placed if not sampled: PCC SLAB
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: FWI 3018-A1
Lot number:
Sublot number:
Aggregate Mix Number:

Test Results