Sample Record
Owner Lab
- Sequoia Consultants
DIME Sample ID 2021-06-26-8
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Project Information
| Project Identifiers | Project ID: 214355 DEA: 120K0214 EFIS: 1214000096 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-5-12.4/14.5 |
| Award Date | 12/20/2019 |
| Closeout Date | Not set |
| Work Description | South 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 Description | ORANGE 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 Level | 1 (Verified on 10/31/2019) |
Sample Information
| Sample Taken Date | 06/26/2021 | Sample Unique Key | 8 |
|---|---|---|---|
| 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 | 06/28/2021 |
| Sample type | Quality Control | A brief description of the sample | 6x12 concrete cylinders |
| The quantity of what the sample constitutes | 100 CYDS | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Ana | Last name of sampler or witnessed by | Nunnally |
| Title of sampler | Field Technician | Telephone number of sampler | |
| Laboratory sample identification | C062621-101 | Linked DIME Sample ID | 2021-06-26-7-1 |
| The fabricator/manufacturer/facility name | Cemex San Juan Capistrano | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name | Avery Parkway Bridge Diaphragms |
Material Information
| Material Type | Concrete | The concrete mix design number | 1614705 |
|---|---|---|---|
| The truck number from where the sample was collected | 10067286 | The batch plant ticket number from where the sample was collected | 29715160 |
| Concrete batch plant | Cemex San Juan Capistrano | The fabricator/manufacturer designation for the sample | Mix |
| A detailed description of where the material sample was collected | Discharge chute from back of truck | Where the material sample would have been placed if not sampled | Diaphragms |
| From Lot No. | Bag Lot No. |
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2021-06-26-8-1 CTM 521-June 2020 (Verified)