Sample Record for 2022-12-07-17
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: 2022-12-07-17
TL Number from the TL Form: 1
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 12/07/2022
Date that the sample was received by the laboratory/organization performing the testing: 12/09/2022
The quantity of what the sample constitutes: 4
A brief description of the sample: Concrete Cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 1015-1207
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Lane Security Joint Venture
Material Information
The concrete mix design number: 1613385
The truck number from where the sample was collected: 10064186
The batch plant ticket number from where the sample was collected: 52261072
Concrete batch plant: Cemex Corona
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Elc Frame 3 - 2 Span 10 and 11 Deck Pour Load 17
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
Tests Assigned to this Sample
| DIME Test ID | Test Method | Assigned Date | Test Date | Assigned By | Assigned Lab | Test Comments | Assigned To |
| 2022-12-07-17-1 | ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens | 12/12/2022 | 01/04/2023 | Jose Mendez | CT D08 - Fontana Southern Regional Laboratory | | |
67374
