Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001219 DEA: 021J8904 EFIS: 0221000006
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-5-R30.5/R31.0
Work Description: REPLACE PAVEMENT AND PLACE POLYESTER CONCRETE OVERLAY.
Location Description: SHASTA COUNTY NEAR O\'BRIEN FROM 0.1 MILE SOUTH OF TUNNEL GULCH VIADUCT TO THE O\'BRIEN REST AREA
Contractor Name: MCCUEN CONSTRUCTION, INC.
Contractor Address: 3269 SWETZER ROAD, Loomis CA 95650
Resident Engineer: Kyle Higgins Structure Rep.: Chris Brace
DIME Sample ID: 2025-09-05-102
TL Number from the TL Form:
Sample Submitted By Organization: G3 Quality, Incorporated - Cerritos
Sample Organization Contact: (562) 321-9840
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 09/05/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/05/2025
The quantity of what the sample constitutes: 20
A brief description of the sample: 4 x 8 Concrete Cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 85373-1 TP Set 1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Precision Concrete Materials
The concrete mix design number: 85373-1 TP
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 0
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Precision Concrete
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-09-05-102-1
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
Data has not been verified.
DIME Test ID: 2025-09-05-102-2
Test Method: CTM 518-June 2010: Method of Test for Unit Weight of Fresh Concrete
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
Data has not been verified.
DIME Test ID: 2025-09-05-102-3
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
Data has not been verified.
DIME Test ID: 2025-09-05-102-4
Test Method: CTM 556-January 2018: Method of Test for Slump of Fresh Portland Cement Concrete
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
Data has not been verified.
DIME Test ID: 2025-09-05-102-5
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
Data has not been verified.
DIME Test ID: 2025-09-05-102-6
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
Data has not been verified.
DIME Test ID: 2025-09-05-102-7
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: G3 Quality, Incorporated - Cerritos
Organization Address: 13850 Cerritos Corporate Drive, Unit E,
Organization City: Cerritos
Organization State: CA
Organization Zipcode: 90703
Organization Email: hwalker@g3quality.com
Organization Phone: 562-321-9853
Data has not been verified.
