Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001104 DEA: 072XR204 EFIS: 0725000163
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1-VAR
Work Description: BID ITEM : STEEL SOLDIER PILE (W12X120) ASTM A992 Gr 50, Bare Steel, 100% Domestic 38 PILES AVAILABLE IMMEDIATELY FROM STOCK 37 PILES AVAILABLE FROM FUTURE MILL ROLL OF 3/16/25 Supplied as: 75 EA. @ 33'9"
Location Description: PCH
Contractor Name: Myers & Sons Construction
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Steve Zaw Structure Rep.: Mehrzad Moheb
DIME Sample ID: 2025-07-28-23
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: 07/28/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/29/2025
The quantity of what the sample constitutes: 8 cy
A brief description of the sample: Concrete
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pro- Cast Products, Inc.
The concrete mix design number: PRO1805125
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 1
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Ready Mix Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
