Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210160 DEA: 101E2204 EFIS: 1015000011 COOP: 10439
QA Service Level: 2
DIST-CO-RTE-PM: 10-SJ-580-13.3/13.8
Work Description: Widen existing road under I-580 to accommodate ramp widening and additional left turn lanes . Proposes to replace existing two lane bridge over the adjacent California Aqueduct on the east side of the Interchange and add two additional lanes
Location Description: Between I-580 and Old Schulte Road
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Rob Shackelford Structure Rep.: Howard Zabell
DIME Sample ID: 2025-06-11-81
TL Number from the TL Form:
Sample Submitted By Organization: Construction Testing Services
Sample Organization Contact: (925) 351-6905
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 06/11/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/12/2025
The quantity of what the sample constitutes: 95
A brief description of the sample: 4x8 cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Tracy
The concrete mix design number: 1616182
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 31638228
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: 1+81 retaining wall
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
