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Sample Record for 2024-02-02-12

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

Project Information

Project ID: 995498 DEA: 072XL104 EFIS: 0724000158 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-14.23
Work Description: Column Casings Repair Work
Location Description:
Contractor Address: 13170 TELEFAIR AVE, SYLMAR, CA 91342
Resident Engineer: Sepand Minovi Structure Rep.: Suh Kwangsuk

Sample Information

DIME Sample ID: 2024-02-02-12
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 02/02/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 15
A brief description of the sample: SCC
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CATALINA PACIFIC

Material Information

The concrete mix design number: 45ESCC
The truck number from where the sample was collected: 3866
The batch plant ticket number from where the sample was collected: 1902829
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Back of truck chute
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results