Sample Record
Owner Lab
- Sequoia Consultants
DIME Sample ID 2023-11-28-58
Project Information
Project Identifiers | Project ID: 214355 DEA: 120K0214 EFIS: 1214000096 |
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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 | 11/28/2023 | Sample Unique Key | 58 |
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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 | 11/29/2023 |
Sample type | Quality Control | A brief description of the sample | structural concrete |
The quantity of what the sample constitutes | 2 cylinders | From where was the sample collected | Job Site |
First name of sampler or witnessed by | William | Last name of sampler or witnessed by | Spigner |
Title of sampler | Telephone number of sampler | ||
Laboratory sample identification | Linked DIME Sample ID | ||
The fabricator/manufacturer/facility name | cemex | Transportation Laboratory (TL) Number | |
Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
Structure name |
Material Information
Material Type | Concrete | The concrete mix design number | 1614705 |
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The truck number from where the sample was collected | The batch plant ticket number from where the sample was collected | 31027987 | |
Concrete batch plant | The fabricator/manufacturer designation for the sample | ||
A detailed description of where the material sample was collected | RW 748 Type 1 ( Mod ) wall Sta 20+24 | Where the material sample would have been placed if not sampled | |
From Lot No. | Bag Lot No. |
Sample File Attachments
File Name | Extension | Date Uploaded | Actions |
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No results found. |
Test File Attachments
DIME Test ID: 2023-11-28-58-1 CTM 521-June 2020 (Verified)