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Sample Record for 2023-02-03-19

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

Project Information

Project ID: 214344 DEA: 120P42U4 EFIS: 1216000097 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5,22,55,57,91,405-Var
Work Description: Upgrade and install Intelligent Transportation System (ITS) elements
Location Description: ORANGE COUNTY
Contractor Name: ILB Electric
Contractor Address: 3955 Temescal Canyon Rd., Corona, CA 92883
Resident Engineer: Bibars Kattao Structure Rep.: Bijan Ronagh-Langroodi

Sample Information

DIME Sample ID: 2023-02-03-19
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: 02/03/2023
Date that the sample was received by the laboratory/organization performing the testing: 02/03/2023
The quantity of what the sample constitutes: 10 cubic yards
A brief description of the sample: 1", 3/8" & SAND
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0073
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CEMEX - ORANGE

Material Information

The concrete mix design number: 1610825
The truck number from where the sample was collected: 10067813
The batch plant ticket number from where the sample was collected: 30615277
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results