Sample Record
Owner Labs
- CT HQ - QASI Los Angeles Field Office
- CT D08 - Fontana Southern Regional Laboratory
DIME Sample ID 2019-11-04-2
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Project Information
| Project Identifiers | Project ID: 213750 DEA: 120K0224 EFIS: 1214000097 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-5-14.5/17.1 |
| Award Date | 03/05/2019 |
| Closeout Date | Not set |
| 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 |
| QA Service Level | 1 (Verified on 04/15/2019) |
Sample Information
| Sample Taken Date | 11/04/2019 | Sample Unique Key | 2 |
|---|---|---|---|
| Will the laboratory/organization for which you are a member perform testing on this material sample? | Yes | Date that the sample was received by the laboratory/organization performing the testing | 11/06/2019 |
| Sample type | Control Sample | A brief description of the sample | 4"x8" Cylinders |
| The quantity of what the sample constitutes | 3 cyliners | From where was the sample collected | Fabricator |
| First name of sampler or witnessed by | Rigoberto | Last name of sampler or witnessed by | Marin |
| Title of sampler | QA | Telephone number of sampler | 951-500-0685 |
| Laboratory sample identification | 3-28-1 of 3, 3-28- 2 of 3, 3-28- 3 of 3 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | SureCast | Transportation Laboratory (TL) Number | 502 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name | Retaining Wall |
Material Information
| Material Type | Concrete | The concrete mix design number | 1418596 |
|---|---|---|---|
| The truck number from where the sample was collected | 2 | The batch plant ticket number from where the sample was collected | 42472271 |
| Concrete batch plant | CEMEX | The fabricator/manufacturer designation for the sample | Unknown |
| A detailed description of where the material sample was collected | wheelbarrow | Where the material sample would have been placed if not sampled | Unknown |
| From Lot No. | Unknown | Bag Lot No. | Unknown |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2019-11-04-2-1 ASTM C39-10 (Verified)