Sample Record for 2015-05-20-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 209217 DEA: 080F5404 EFIS: 0800000136 COOP: 081468
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-91,15-0.0/13.04, 35.64/45.14
Work Description: SR-91 Corridor Improvement Project: Develop approx. 8 miles of tolled express lanes and related improvements within SR 91 between the Riverside/Orange County line and I-15, including transition areas.
Location Description: 08-RIV-91-0.0/13.04; 12-ORA-91-R14.43/R18.91; 08-RIV-15-35.64/45.14
Contractor Name: Atkinson Walsh, Joint Venture
Contractor Address: 1785 Sampson Ave, Corona, CA 92879
Resident Engineer: Richard Hebert Structure Rep.: Cyrus Shahinpar
Sample Information
DIME Sample ID: 2015-05-20-3
TL Number from the TL Form: SRL 52
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: 05/20/2015
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2015
The quantity of what the sample constitutes: 8
A brief description of the sample: 6X12
From where was the sample collected: Job Site
Laboratory sample identification: 888 SRL52
Structure unique identifier: 91 CIP
Structure name: BR 01 DECK
The fabricator/manufacturer/facility name: JOB
Material Information
The concrete mix design number: 3X50L001
The truck number from where the sample was collected: 287
The batch plant ticket number from where the sample was collected: 118024444935
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: LOAD 2
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
