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Sample Record for 2015-03-04-7

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 7613 DEA: 071218W4 EFIS: 0700021119 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-29.4/31.6
Work Description: REALIGN ROUTE 5 AND RAILROAD TRACKS AND RECONFIGURE ON- AND OFF-RAMPS.
Location Description: LOS ANGELES COUNTY IN BURBANK FROM WEST MAGNOLIA BOULEVARD OVERCROSSING TO 0.3 MILE NORTH OF BUENA VISTA STREET/WINONA AVENUE UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Vladimir Gurfinkel Structure Rep.: Gon Choi

Sample Information

DIME Sample ID: 2015-03-04-7
TL Number from the TL Form: 150403
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 03/04/2015
Date that the sample was received by the laboratory/organization performing the testing: 03/12/2015
The quantity of what the sample constitutes: 6
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 889-03
Structure unique identifier: RW1615
Structure name: STEM POUR
The fabricator/manufacturer/facility name: FIELD

Material Information

The concrete mix design number: S62578
The truck number from where the sample was collected: 469
The batch plant ticket number from where the sample was collected: 176364
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: NATIONAL READY MIX
A detailed description of where the material sample was collected: CHUTE
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 IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.