Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993551 DEA: 07279124 EFIS: 0715000076
QA Service Level: 2
DIST-CO-RTE-PM: 07-LA-57-60-R4.3/R4.5
Work Description: STATE ROUTE 57 and 60 HIGHWAYS CONFLUENCE CHOKEPOINT RELIEF PROJECT PHASE II
Location Description: CITY of DIAMOND BAR and CITY of INDUSTRY LOS ANGELES COUNTY, CALIFORNIA
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Martin Sandoval Structure Rep.: Thomas Tong
DIME Sample ID: 2025-05-02-80
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: 05/02/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/03/2025
The quantity of what the sample constitutes: 1 per 100 cy or a fraction thereof
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 Ready Mix Pomona
The concrete mix design number: 5264125A
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 1543460
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: RW254- Stem wall Sta# 15+44 to 16+35
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-05-02-80-1
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.
