Sample Record for 2015-03-10-5
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 209141 DEA: 07215954 EFIS: 0700001835
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-0.0/7.6
Work Description: WIDENING FREEWAY AND RECONSTRUCT OVERHEAD AND OVERCROSSING STRUCTURES
Location Description: LOS ANGELES COUNTY IN LA MIRADA, SANTA FE SPRINGS, NORWALK AND DOWNEY FROM ORANGE COUNTY/LOS ANGELES COUNTY LIMIT LINES TO 0.7 MILE NORTH OF ROUTE 605
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Thang Ton Structure Rep.: Amare Tsagie
Sample Information
DIME Sample ID: 2015-03-10-5
TL Number from the TL Form: C916887
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 03/10/2015
Date that the sample was received by the laboratory/organization performing the testing: 03/10/2015
The quantity of what the sample constitutes: 2 bags
A brief description of the sample: Class 4 Aggregate Subbase
From where was the sample collected: Job Site
Laboratory sample identification: 5032B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: None
Material Information
Source Identification (SMARA, name of Pit or Job Site): 25th Street Recycling
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Stockpile at Sta 327 00
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size:
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
