Sample Record for 2023-05-23-12
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213750 DEA: 120K0224 EFIS: 1214000097
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-14.5/17.1
Work Description: South County Improvement Project (Phase 2 - Oso/Alicia) CONST BRIDGES, RW, SW, HMA PVMT, JPCP, DRAINAGE, AND ELECT SYSTEMS.
Location Description: ORANGE COUNTY IN MISSION VIEJO AND LAGUNA HILLS FROM 0.7 MILE SOUTH OF OSO PARKWAY OVERCROSSING TO 0.3 MILE SOUTH OF ALICIA PARKWAY OVERCROSSING
Contractor Name: Flatiron West, Inc
Contractor Address: 1770 La Costa Meadows Drive, San Marcos, California 92078
Resident Engineer: Steven Kim Structure Rep.: Sara Soleimani
Sample Information
DIME Sample ID: 2023-05-23-12
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: 05/23/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/23/2023
The quantity of what the sample constitutes: 300 CU.YDS
A brief description of the sample: 1", 3/8" & SAND
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0456
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CEMEX - IRVINE
Material Information
The concrete mix design number: 1605760
The truck number from where the sample was collected: 10067294
The batch plant ticket number from where the sample was collected: 30752766
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: conveyor belt
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results