Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214451 DEA: 07303704 EFIS: 0714000035
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101-8.0/27.3
Work Description: REPLACE CONCRETE BARRIERS.
Location Description: THE CITY AND COUNTY OF LOS ANGELES FROM PILGRIMAGE OVERCROSSING TO VALLEY CIRCLE BOULEVARD OVERCROSSING
Contractor Name: OHL USA
Contractor Address: 1920 Main Street, Suite 310, Irvine, California 92614
Resident Engineer: Kevin Bui Structure Rep.: Kwangsuk Suh
DIME Sample ID: 2022-02-07-40
TL Number from the TL Form:
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: 02/07/2022
Date that the sample was received by the laboratory/organization performing the testing: 02/11/2022
The quantity of what the sample constitutes: Three Bags
A brief description of the sample: Coarse and fine aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: National Van Nuys
Source Identification (SMARA, name of Pit or Job Site): United
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: Ground Pile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: S58522
Lot number:
Sublot number:
Aggregate Mix Number:
