Sample Record for 2015-10-12-7
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 7428 DEA: 07215944 EFIS: 0700001834
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-4.0/5.9
Work Description: RECONSTRUCT AND WIDEN FREEWAY AND UNDERCROSSING STRUCTURES.
Location Description: LOS ANGELES COUNTY IN NORWALK FROM 0.4 MILE SOUTH OF SAN ANTONIO DRIVE UNDERCROSSING TO 0.7 MILE NORTH OF PIONEER BOULEVARD UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Jerome Arabe Structure Rep.: Amare Tsegie
Sample Information
DIME Sample ID: 2015-10-12-7
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 10/12/2015
Date that the sample was received by the laboratory/organization performing the testing: 10/28/2015
The quantity of what the sample constitutes: 25 Bags
A brief description of the sample: LCB
From where was the sample collected: Source
Laboratory sample identification: 5268B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: 25th Street Crushing Plant
Material Information
Source Identification (SMARA, name of Pit or Job Site): Unknown
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: The Belt from 25th Street Crushing Plant
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size:
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
