Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994396 DEA: 07330304 EFIS: 0716000213
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-22.0/30.8
Work Description: CONSTRUCT CONCRETE BARRIER AND STRUCTURAL CONCRETE BARRIER SLAB.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS FROM 0.6 MILE EAST OF ROUTE 710/10 SEPARATION TO 0.3 MILE WEST OF ROUTE 10/605 SEPARATION
Contractor Name: FEC FUTURE CONTRACTORS AND ENGINEERS, INC.
Contractor Address: 184 TECHNOLOGY DRIVE, SUITE 2, IRVINE CA 92618
Resident Engineer: Edgar Herrera Structure Rep.: Ryan Ramos
DIME Sample ID: 2025-05-11-11
TL Number from the TL Form:
Sample Submitted By Organization: FEC Future Contractors and Engineers, Incorporated
Sample Organization Contact: (949) 217-9050
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/11/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/11/2025
The quantity of what the sample constitutes: 8 Cylinders
A brief description of the sample: JPCP-RSC
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex
The concrete mix design number: 1621261
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 31607724
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: During pouring from the mixing truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
