Sample Record for 2022-08-03-26
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212112 DEA: 080C2514 EFIS: 0816000076 COOP: 081645
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-0.0/13.2
Work Description: Design-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes
Location Description: LA/SBD County Line to PM 13.2 near I-15
Contractor Name: Lane-Security Paving Joint Venture
Contractor Address: 3450 Centre Lake Drive, 1st Floor, Ontario, CA 91761
Resident Engineer: Jose Corona Structure Rep.: Luis Negrete
Sample Information
DIME Sample ID: 2022-08-03-26
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 08/03/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/03/2022
The quantity of what the sample constitutes: 4 Bags Coldfeed Agg., 1 Bag Rap
A brief description of the sample: 1 x 4 PCC Aggregate and Sand
From where was the sample collected: Manufacturer
Laboratory sample identification: TEST 1 AT 900 OF 30CY OUT
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: LANEsecurity paving
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-36-0040
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number: 220831 CORD SJR
A detailed description of where the material sample was collected: Belt Cut at Vulcan-Corona Drum
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 1-1/2 inch
The concrete mix design number: 1610974
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
