Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000607 DEA: 081K6904 EFIS: 0819000090
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-5.7/11.8
Work Description: ROCK EXCAVATION, HMA (TYPE A), RHMA-G, AND CABLE NET DRAPERY SYSTEM.
Location Description: RIVERSIDE COUNTY IN AND NEAR LAKE ELSINORE FROM MONTE VISTA STREET TO GRAND AVENUE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Joseph Lopez Structure Rep.: Unknown
DIME Sample ID: 2026-01-07-45
TL Number from the TL Form:
Sample Submitted By Organization: Thompson Pipe Group - Los Angeles
Sample Organization Contact: (909) 201-5127
Type of Sample: Quality Control
Type of Material: Precast Concrete
Sample Taken Date: 01/07/2026
Date that the sample was received by the laboratory/organization performing the testing: 01/07/2026
The quantity of what the sample constitutes: 2.5cy
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Thompson pipe group
The concrete mix design number: CT6002PH
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 272147
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Conveyor Belt
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
