Sample Record for 2016-03-14-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 210737 DEA: 073X7114 EFIS: 0715000132
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-60,126-R7.4/R8.1
Work Description: REALIGN RAMPS, WIDEN BRIDGE, AND REPLACE RAMPS PAVEMENT.
Location Description: IN LA COUNTY, IN CITY OF MONTEBELLOAT PARAMOUNT BOULEVARD OVERCROSSING
Contractor Name: POWELL CONSTRUCTORS, INC.
Contractor Address: 8555 Banana Ave., Fontana, CA 92335
Resident Engineer: Ragy Samy Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2016-03-14-1
TL Number from the TL Form: 1269494
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 03/14/2016
Date that the sample was received by the laboratory/organization performing the testing: 03/16/2016
The quantity of what the sample constitutes: 4
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 929-94
Structure unique identifier: Unknown
Structure name: Unknown
The fabricator/manufacturer/facility name: Plant
Material Information
The concrete mix design number: S62578
The truck number from where the sample was collected: 361
The batch plant ticket number from where the sample was collected: 1269494
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Plant
A detailed description of where the material sample was collected: Batch Plant
Where the material sample would have been placed if not sampled: 60 Paramount WB off Ramp
From Lot No.: Unknown
Bag Lot No.: Unknown
Test Results
