Sample Record for 2015-03-11-2
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: 2015-03-11-2
TL Number from the TL Form: 101045797
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: 03/11/2015
Date that the sample was received by the laboratory/organization performing the testing: 03/12/2015
The quantity of what the sample constitutes: 8
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 882-97
Structure unique identifier: LARK ELLEN AVE UC
Structure name: COLUMNS
The fabricator/manufacturer/facility name: FIELD
Material Information
The concrete mix design number: CM5645
The truck number from where the sample was collected: 198
The batch plant ticket number from where the sample was collected: 1010459797
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: HOLLIDAY ROCK
A detailed description of where the material sample was collected: TRUCK
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
