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Sample Record for 2015-05-26-2

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

Project Information

Project ID: 209511 DEA: 080Q7403 EFIS: 0800020456 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-15.4/30.8
Work Description: Design Build project provides pavement rehabilitation (including ramps) on I-15 near Cajon Pass, CA.
Location Description: On I-15 from 0.4 mile north of Kenwood Avenue to 0.3 mile south of West Hesperia OH
Contractor Name: Coffman Specialties, Inc./Parsons Transportation Group, Inc
Contractor Address: 9685 VIA EXCELENCIA, SUITE 200, SAN DIEGO, CA 92126
Resident Engineer: Maged Youssef Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2015-05-26-2
TL Number from the TL Form: LCB 26
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: 05/26/2015
Date that the sample was received by the laboratory/organization performing the testing: 05/28/2015
The quantity of what the sample constitutes: 4
A brief description of the sample: 6X12
From where was the sample collected: Job Site
Laboratory sample identification: 888-26
Structure unique identifier: CAJON PASS
Structure name: SBD I15 PM R15 4 TO 30 8
The fabricator/manufacturer/facility name: JOB

Material Information

The concrete mix design number: 1202-8
The truck number from where the sample was collected: 67
The batch plant ticket number from where the sample was collected: 31
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: LOAD 31
Where the material sample would have been placed if not sampled: Unknown
From Lot No.:
Bag Lot No.:

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
2015-05-26-2-1CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders05/28/201505/29/2015Matthew ClaytonCT - Southern Regional Laboratory3 DAY