Sample Record for 2023-01-13-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214951 DEA: 120K0234 EFIS: 1214000100
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-17.1/18.9
Work Description: South County Improvement Project (Phase 3 - El Toro/Alicia) WIDEN FREEWAY AND BRIDGES, RECONSTRUCT BRIDGE AND WALLS.
Location Description: ORANGE COUNTY IN MISSION VIEJO, LAGUNA HILLS, LAGUNA WOODS AND LAKE FOREST FROM 0.4 MILE SOUTH OF ALICIA PARKWAY OVERCROSSING TO 0.2 MILE NORTH OF EL TORO ROAD UNDERCROSSING
Contractor Name: GUY F. ATKINSON CONSTRUCTION, LLC
Contractor Address: 18201 Von Karman Ave #800, Irvine, CA 92612
Resident Engineer: Irvin Nguyen Structure Rep.: Jason Kim
Sample Information
DIME Sample ID: 2023-01-13-4
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 01/13/2023
Date that the sample was received by the laboratory/organization performing the testing: 01/13/2023
The quantity of what the sample constitutes: 10 Cy
A brief description of the sample: Coarse PCC Aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0014
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Holliday Rock Santa Ana
Material Information
The concrete mix design number: 3F40L032
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 125097
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: At the plant
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
