Sample Record for 2025-07-28-30
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000697 DEA: 021J75U4 EFIS: 0224000092
QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS-36-14.4/R16.8
Work Description: PLACE HMA AND CLASS 2 AB, EXCAVATE ROADWAY, & INSTALL LIGHTING SYSTEM.
Location Description: LASSEN COUNTY ABOUT 9 MILES WEST OF SUSANVILLE FROM 1.3 MILES WEST TO 1.2 MILES EAST OF WILLARD CREEK ROAD
Contractor Name: HAT CREEK CONSTRUCTION & MATERIALS, INC.
Contractor Address: HAT CREEK CONSTRUCTION & MATERIALS, INC. 24339 Hwy 89 North, burney, CA, 96013
Resident Engineer: Daniel Gibbs Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2025-07-28-30
TL Number from the TL Form:
Sample Submitted By Organization: Structure Cast
Sample Organization Contact: (661) 301-2624
Type of Sample: Quality Control
Type of Material: Precast Concrete
Sample Taken Date: 07/28/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/24/2025
The quantity of what the sample constitutes: 5.5 cy
A brief description of the sample: SCC
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Structure Cast
Material Information
The concrete mix design number: 9skscc-TIT
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 111111
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
