Sample Record

Owner Lab

  • Sequoia Consultants

DIME Sample ID 2021-02-01-35

Project Information

Project IdentifiersProject ID: 214909
DEA: 120N8604
EFIS: 1214000123
DIST-CO-RTE-PM12-ORA-73-23.7/24.1
Award Date06/25/2020
Closeout DateNot set
Work DescriptionREPLACE STRUCTURAL CONCRETE BRIDGE & RETAINING WALL; & PLACE HMA.
Location DescriptionORANGE COUNTY IN NEWPORT BEACH FROM 0.3 MILE NORTH OF BISON AVENUE TO 0.3 MILE SOUTH OF UNIVERSITY DRIVE
QA Service Level1 (Verified on 07/21/2020)

Sample Information

Sample Taken Date02/01/2021 Sample Unique Key35
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 testing02/02/2021
Sample typeQuality Control A brief description of the samplestructural concrete
The quantity of what the sample constitutes2 From where was the sample collectedJob Site
First name of sampler or witnessed byDerek Bezotte Last name of sampler or witnessed byDerek Bezotte
Title of samplerMr Telephone number of sampler7149746316
Laboratory sample identificationC020121-101 Linked DIME Sample ID-
The fabricator/manufacturer/facility nameCemex Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier12-0N8604
Structure nameRetaining Wall 350

Material Information

Material TypeConcrete The concrete mix design number1614705
The truck number from where the sample was collected10070515 The batch plant ticket number from where the sample was collected29455279
Concrete batch plantirvine The fabricator/manufacturer designation for the sampleMix
A detailed description of where the material sample was collectedOnsite Where the material sample would have been placed if not sampled
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2021-02-01-35-1CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylindersshamila RanjanSequoia Consultants03/01/2021shamila Ranjan
No
Info