Sample Record for 2016-08-12-17
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 209217 DEA: 080F5404 EFIS: 0800000136 COOP: 081468
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-91,15-0.0/13.04, 35.64/45.14
Work Description: SR-91 Corridor Improvement Project: Develop approx. 8 miles of tolled express lanes and related improvements within SR 91 between the Riverside/Orange County line and I-15, including transition areas.
Location Description: 08-RIV-91-0.0/13.04; 12-ORA-91-R14.43/R18.91; 08-RIV-15-35.64/45.14
Contractor Name: Atkinson Walsh, Joint Venture
Contractor Address: 1785 Sampson Ave, Corona, CA 92879
Resident Engineer: Richard Hebert Structure Rep.: Cyrus Shahinpar
Sample Information
DIME Sample ID: 2016-08-12-17
TL Number from the TL Form: SRL330
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: 08/12/2016
Date that the sample was received by the laboratory/organization performing the testing: 10/12/2016
The quantity of what the sample constitutes: 2
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 888-SRL330
Structure unique identifier: NP
Structure name: Unknown
The fabricator/manufacturer/facility name: Holliday Rock Chino
Material Information
The concrete mix design number: CM5634
The truck number from where the sample was collected: 290
The batch plant ticket number from where the sample was collected: 118054162
Concrete batch plant: NP
The fabricator/manufacturer designation for the sample: NP
A detailed description of where the material sample was collected: LOAD 12
Where the material sample would have been placed if not sampled: WALL 141 C
From Lot No.: NP
Bag Lot No.: Unknown
Test Results
