Sample Record for 2022-10-04-62
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213749 DEA: 120C1104 EFIS: 1200000633
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-57-20.3/21.6
Work Description: SR-57 Lambert Interchange Project: WIDEN BRIDGES AND CONSTRUCT RW, SW, HMA, JPCP AND ELECTRICAL SYSTEMS.
Location Description: ORANGE COUNTY IN BREA FROM 0.6 MILE SOUTH TO 0.7 MILE NORTH OF LAMBERT ROAD UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Steven Kim Structure Rep.: Theodore Pham
Sample Information
DIME Sample ID: 2022-10-04-62
TL Number from the TL Form:
Sample Submitted By Organization: Ninyo & Moore
Sample Organization Contact: (949) 795-9464
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 10/04/2022
Date that the sample was received by the laboratory/organization performing the testing: 10/05/2022
The quantity of what the sample constitutes: 70CY
A brief description of the sample: Concrete Beams
From where was the sample collected: Job Site
Laboratory sample identification: 157675
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Security Paving
Material Information
The concrete mix design number: G3-19-PCC-001
The truck number from where the sample was collected: 5
The batch plant ticket number from where the sample was collected: 204913
Concrete batch plant: Security Paving
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Back of truck, Load 1
Where the material sample would have been placed if not sampled: PAVEMENT SLAB
From Lot No.:
Bag Lot No.:
Test Results
Test 1 of 1
DIME Test ID: 2022-10-04-62-1
Test Method: ASTM C293-10: Standard Test Method for Flexural Strength of Concrete (Using Simple Beam With Center-Point Loading)
Submitted By Organization: Ninyo & Moore
Organization Address: 475 Goddard, Suite 200,
Organization City: Irvine
Organization State: CA
Organization Zipcode: 92618
Organization Email: aerodriguez@ninyoandmoore.com
Organization Phone: 1 (949) 795-9464
Data has not been verified.
