Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001110 DEA: 06484674 EFIS: 0623000083 COOP: 061794
QA Service Level: 2
DIST-CO-RTE-PM: 06-KER--
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Albert Heredia
DIME Sample ID: 2025-06-30-65
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 06/30/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2025
The quantity of what the sample constitutes: 2 cylinders
A brief description of the sample: structural concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Alliance Ready Mix
The concrete mix design number: ES25-002
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 431195
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Bent 3 CIDH - EB 58/NB 99
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-06-30-65-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: Sequoia Consultants
Organization Address: 361 West Grove Avenue,
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email: sranjan@sequoiacon.com
Organization Phone: 1 (714) 974-6316
Data has not been verified.
