Sample Record for 2022-05-10-3
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: 2022-05-10-3
TL Number from the TL Form: 1001
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: 05/10/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/10/2022
The quantity of what the sample constitutes: 400
A brief description of the sample: 1x 4 Pcc Aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Security Paving batch plant
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-13-0098
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: conniver belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
Tests Assigned to this Sample
| DIME Test ID | Test Method | Assigned Date | Test Date | Assigned By | Assigned Lab | Test Comments | Assigned To |
| 2022-05-10-3-1 | CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse Aggregates | 05/10/2022 | 05/10/2022 | Zaid Hilli | CT D07 - Plant Services | zdcc | |
56885
