Sample Record for 2025-05-23-51
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000102 DEA: 081J8504 EFIS: 0818000122
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-2,10,18,38,138,etc.-Var
Work Description: FURNISH SIGN STRUCTURE AND INSTALL CHANGEABLE MESSAGE SIGN SYSTEM.
Location Description: SAN BERNARDINO COUNTY AT VARIOUS LOCATIONS
Contractor Name: POWELL CONSTRUCTORS INC
Contractor Address: 8555 BANANA AVE, FONTANA, CA 92335
Resident Engineer: George Elzawy Structure Rep.: Ravinder Singh
Sample Information
DIME Sample ID: 2025-05-23-51
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: 05/23/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/24/2025
The quantity of what the sample constitutes: 5 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: Robertsons Lake Arrowhead
Material Information
The concrete mix design number: RRM09014
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 613266
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Truck Trial Plant #9 Lake Arrowhead
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
