Sample Record for 2015-03-05-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 209139 DEA: 071170U4 EFIS: 0700000085
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-33.2/37.2
Work Description: CONSTRUCT HOV LANES, WIDEN BRIDGES, AND REALIGN RAMPS.
Location Description: LOS ANGELES COUNTY IN BALDWIN PARK AND WEST COVINA FROM 0.1 MILE WEST OF PUENTE AVENUE UNDERCROSSING TO 0.2 MILE EAST OF HOLLENBECK STREET UNDERCROSSING
Contractor Name: Ames Construction, inc.
Contractor Address: 391 N Main Street, Suite 302, Corona, Ca 92880
Resident Engineer: Raj Punjabi Structure Rep.: Cardiel Bugarin
Sample Information
DIME Sample ID: 2015-03-05-3
TL Number from the TL Form: OCPP001
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 03/05/2015
Date that the sample was received by the laboratory/organization performing the testing: 03/09/2015
The quantity of what the sample constitutes: 2
A brief description of the sample: Cylinder
From where was the sample collected: Job Site
Laboratory sample identification: Unknown
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: site
Material Information
The concrete mix design number: 85F152
The truck number from where the sample was collected: na
The batch plant ticket number from where the sample was collected: 49943
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Casting Line A1 Bulb Tee Girder B1
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
Tests Assigned to this Sample
| DIME Test ID | Test Method | Assigned Date | Test Date | Assigned By | Assigned Lab | Test Comments | Assigned To |
| 2015-03-05-3-1 | CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders | 03/09/2015 | 03/12/2015 | Matthew Clayton | CT D08 - Fontana Southern Regional Laboratory | 7 day | |
1365
