Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995193 DEA: 07356604 EFIS: 0719000026
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-605-R10.2/20.2
Work Description: LANE & SLAB REPLACEMENT, COLD PLANE & HMA OVERLAY.
Location Description: LOS ANGELES COUNTY IN SANTA FE SPRINGS, PICO RIVERA, WHITTIER, CITY OF INDUSTRY AND EL MONTE FROM TELEGRAPH ROAD UNDERCROSSING TO ROUTE 605/10 SEPARATION
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Jerome Arabe Structure Rep.: Tien Chu
DIME Sample ID: 2025-04-23-23
TL Number from the TL Form:
Sample Submitted By Organization: Alta Vista Solutions - Whittier
Sample Organization Contact: (510) 542-9827
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/23/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/23/2025
The quantity of what the sample constitutes: 10 CY
A brief description of the sample: A set of 3 JPCP RSC beams
From where was the sample collected: Job Site
Laboratory sample identification: 25-1305
Structure unique identifier:
Structure name: SB 605 Fwy @ Rosehills SB Off Ramp
The fabricator/manufacturer/facility name: N/A
The concrete mix design number: VCTS675
The truck number from where the sample was collected: Truck 2204
The batch plant ticket number from where the sample was collected: Load 1
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-04-23-23-1
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 04/25/2025
Date Tested: 04/23/2025
Submitted By Organization: Alta Vista Solutions - Whittier
Organization Address: 12409 Slauson Avenue, Suite I,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90606
Organization Email: nicholas.hoffmann@oneatlas.com
Organization Phone: (510) 542-9827
General Comments for this Test:
Test Result Compliance: not applicable
Additional Comments When Verified:
