Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000663 DEA: 081J3304 EFIS: 0818000019
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD, -15-160.9/161.5
Work Description: BUILDING WORK.
Location Description: SAN BERNARDINO COUNTY NEAR MOUNTAIN PASS FROM 0.2 MILE SOUTH TO 0.4 MILE NORTH OF VALLEY WELLS SAFETY ROADSIDE REST AREA
Contractor Name: TSI ENGINEERING, INC.
Contractor Address: Unknown
Resident Engineer: Khoa Nguyen Structure Rep.: Unknown
DIME Sample ID: 2025-10-13-12
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: 10/13/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/14/2025
The quantity of what the sample constitutes: 3 cy
A brief description of the sample: Ready Mix Concrete
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pro-Cast Products, Inc.
The concrete mix design number: P18051EU
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: Wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-10-13-12-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Submitted By Organization: Pro-Cast Products, Incorporated - Highland
Organization Address: 27417 East Third Street,
Organization City: Highland
Organization State: CA
Organization Zipcode: 92346
Organization Email: bmalott@procastproducts.com
Organization Phone: (909) 809-2429
Data has not been verified.
DIME Test ID: 2025-10-13-12-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Submitted By Organization: Pro-Cast Products, Incorporated - Highland
Organization Address: 27417 East Third Street,
Organization City: Highland
Organization State: CA
Organization Zipcode: 92346
Organization Email: bmalott@procastproducts.com
Organization Phone: (909) 809-2429
Data has not been verified.
DIME Test ID: 2025-10-13-12-3
Test Method: ASTM C39-21: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Submitted By Organization: Pro-Cast Products, Incorporated - Highland
Organization Address: 27417 East Third Street,
Organization City: Highland
Organization State: CA
Organization Zipcode: 92346
Organization Email: bmalott@procastproducts.com
Organization Phone: (909) 809-2429
Data has not been verified.
