Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993223 DEA: 11TEST04 EFIS: 11TEST3101
QA Service Level: 1
DIST-CO-RTE-PM: 11---
Work Description: THIS PROJECT WAS ADDED FOR E3101 DEVELOPMENT AND TESTING PURPOSES. DATA SUBMITTED FOR THIS PROJECT MUST NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT WAS ADDED FOR E3101 DEVELOPMENT AND TESTING PURPOSES. DATA SUBMITTED FOR THIS PROJECT MUST NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: TBD
Contractor Address: TBD, TBD
Resident Engineer: Kieran Fung Structure Rep.: Kieran Fung
DIME Sample ID: 2026-03-16-8
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 03/16/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/16/2026
The quantity of what the sample constitutes: 30 cy
A brief description of the sample: RCB
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pro Cast
Source Identification (SMARA, name of Pit or Job Site): 91-35-0011
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2026-03-16-8-1
Test Method: ASTM C136-19: Standard Test Method for Sieve Analysis of Fine and Coarse Aggregates
Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Organization Address: 13230 East Firestone Boulevard,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: adriana.ortiz@dot.ca.gov
Organization Phone: (323) 805-3068
Data has not been verified.
DIME Test ID: 2026-03-16-8-2
Test Method: ASTM C566-19: Standard Test Method for Total Evaporable Moisture Content of Aggregate by Drying
Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Organization Address: 13230 East Firestone Boulevard,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: adriana.ortiz@dot.ca.gov
Organization Phone: (323) 805-3068
Data has not been verified.
