Sample Record

Owner Lab

  • Sequoia Consultants

DIME Sample ID 2023-06-07-102

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 Date06/07/2023 Sample Unique Key102
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 testing06/08/2023
Sample typeQuality Control A brief description of the samplestructural concrete
The quantity of what the sample constitutes2 cylinders From where was the sample collectedJob Site
First name of sampler or witnessed byDerek Last name of sampler or witnessed byBezotte
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameCemex Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design number1610974
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected30774782
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedSB I-5 avery pkwy abutment 1 approach slab Where the material sample would have been placed if not sampled
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2023-06-07-102-1CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete CylindersEddie Mendez , Sequoia Consultants07/05/2023Erick Menjivar
Yes
11/09/2023

Sample File Attachments

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Test File Attachments


DIME Test ID: 2023-06-07-102-1 CTM 521-June 2020 (Verified)