Sample Record for 2022-02-09-28
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215299 DEA: 07260804 EFIS: 0712000104
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10,405-16.6/30.1,4.8/8.7
Work Description: CONSTRUCT GROSS SOLIDS REMOVAL DEVICES, BIOSWALES AND MEDIA FILTERS.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS ON ROUTE 10 0.1 MILE WEST OF SANTA FE AVENUE TO 0.2 MILE WEST OF COGSWELL ROAD UNDERCROSSING AND ON ROUTE 405 0.1 MILE EAST OF CHEERY AVENUE OVERCROSSING TO 0.1 MILE WEST OF SOUTH ALAMEDA STREET UNDERCROSSING
Contractor Name: POWELL CONSTRUCTORS, INC.
Contractor Address: 1355 Brooks Street, Unit "F", Ontario, CA 91762
Resident Engineer: Mesfin Hailu Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2022-02-09-28
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Plant Services
Sample Organization Contact: 562-345-3126
Type of Sample: Department Acceptance
Type of Material: Aggregate
Sample Taken Date: 02/09/2022
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: Associate Ready Mix - LA
Material Information
Source Identification (SMARA, name of Pit or Job Site): Hanson Irvine
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: 1 inch
The concrete mix design number: 556300
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
