Sample Record for 2015-08-27-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 3807 DEA: 07121844 EFIS: 0700000117
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-42.8/47.3
Work Description: CONSTRUCT HOV LANES, RETAINING WALLS AND SOUND WALLS.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES, GLENDALE, AND BURBANK FROM ROUTE 5/134 SEPARATION TO MAGNOLIA BOULEVARD OVERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: James Shih Structure Rep.: Matthew Remo
Sample Information
DIME Sample ID: 2015-08-27-4
TL Number from the TL Form: 002
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/27/2015
Date that the sample was received by the laboratory/organization performing the testing: 09/02/2015
The quantity of what the sample constitutes: 6
A brief description of the sample: 6X12
From where was the sample collected: Job Site
Laboratory sample identification: 819-02
Structure unique identifier: WESTERN AVE RIGHT BR CLOSURE POUR
Structure name: Unknown
The fabricator/manufacturer/facility name: JOB
Material Information
The concrete mix design number: SM40102
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: NP
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: CHUTE
Where the material sample would have been placed if not sampled: Unknown
From Lot No.:
Bag Lot No.:
Test Results
