Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88887 DEA: PC-Barrier-STOCK EFIS: PC-Barrier-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for precast barrier rail stock material.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-02-19-41
TL Number from the TL Form:
Sample Submitted By Organization: Pro-Cast Products, Incorporated - Highland
Sample Organization Contact: (909) 793-7602
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 02/19/2025
Date that the sample was received by the laboratory/organization performing the testing: 02/20/2025
The quantity of what the sample constitutes: 8
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ProCast Products
The concrete mix design number: P18051R1
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: TT
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
