Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000927 DEA: 101R7204 EFIS: 1023000209
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-5,99-Var
Work Description: PLACE POLYESTER CONCRETE OVERLAY, TRAFFIC STRIPE, COLD PLANE, AND HMA.
Location Description: SAN JOAQUIN COUNTY AT VARIOUS LOCATIONS
Contractor Name: MCCUEN CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: David Abledu Structure Rep.: Unknown
DIME Sample ID: 2025-11-20-3
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3665 - Stockton
Sample Organization Contact: (916) 416-7793
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 11/20/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/20/2025
The quantity of what the sample constitutes: Skid Testing
A brief description of the sample: Skid test on Bridge Deck
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Lathrop Road Undercrossing
The fabricator/manufacturer/facility name: McCuen Construction
The concrete mix design number: polyester concrete overlay
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: AZ5G00794
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Job site
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
