Sample Record

Owner Lab

  • Sequoia Consultant

DIME Sample ID 2021-03-31-10

Project Information

Project IdentifiersProject ID: 214355
DEA: 120K0214
EFIS: 1214000096
DIST-CO-RTE-PM12-ORA-5-12.4/14.5
Award Date12/20/2019
Closeout DateNot set
Work DescriptionSouth County Improvement Project (Phase 1 - Avery/Crown Valley) PLACE HMA, INSTALL CONC PAVEMENT, RETAIN WALL, MODIFY ELECT SYS. | Add one lane btwn 73 & Oso PKWY
Location DescriptionORANGE COUNTY IN SAN JUAN CAPISTRANO, LAGUNA HILLS, LAGUNA NIGUEL AND MISSION VIEJO FROM 0.5 MILE SOUTH OF AVERY PARKWAY UNDERCROSSING TO 0.8 MILE NORTH OF CROWN VALLEY PARKWAY OVERCROSSING
QA Service Level1 (Verified on 10/31/2019)

Sample Information

Sample Taken Date03/31/2021 Sample Unique Key10
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 testing04/01/2021
Sample typeQuality Control A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes100CYDS From where was the sample collectedJob Site
First name of sampler or witnessed byBonnie Last name of sampler or witnessed byBlack
Title of samplerField Technician Telephone number of sampler
Laboratory sample identificationC033121-101 Linked DIME Sample ID
The fabricator/manufacturer/facility nameCemex San Juan Capistrano Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure nameRetaining Wall 715

Material Information

Material TypeConcrete The concrete mix design number1614705
The truck number from where the sample was collected70512 The batch plant ticket number from where the sample was collected29554195
Concrete batch plantCemex San Juan Capistrano The fabricator/manufacturer designation for the sampleMix
A detailed description of where the material sample was collectedDischarge chute from back of truck Where the material sample would have been placed if not sampledRetaining Wall
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2021-03-31-10-1CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete CylindersRuben JimenezSequoia Consultant04/07/2021Ken Mancebo
No
Info