Sample Record for 2022-02-10-34
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 211260 DEA: 072159U4 EFIS: 0715000160
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA,ORA-5-0.0/1.5, 44.3/44.4
Work Description: CONSTRUCT HOV LANES AND MIX FLOW LANES.
Location Description: LOS ANGELES AND ORANGE COUNTIES IN BUENA PARK, LA MIRADA, CERRITOS AND SANTA FE SPRINGS FROM ARTESIA BOULEVARD UNDERCROSSING TO NORTH FORK COYOTE CREEK
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3075 TOWNSGATE RD. SUITE 200, WESTLAKE VILLAGE, CA 91361
Resident Engineer: George Saker Structure Rep.: Danny Lalonde
Sample Information
DIME Sample ID: 2022-02-10-34
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: 02/10/2022
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: SECURITY PAVING - LA MIRADA
Material Information
Source Identification (SMARA, name of Pit or Job Site): Hanson Irwindale
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: G3-17-STR-006F
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
