Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214151 DEA: 080R0104 EFIS: 0812000007
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-91-R0.3
Work Description: STR EXC, FURNISH PRECAST RCB CULVERT AND STR CONC RETAINING WALL.
Location Description: RIVERSIDE COUNTY NEAR CORONA AT 0.7 MILES WEST OF GREEN RIVER ROAD OVERCROSSING
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Mohamad Alsheikh Structure Rep.: Osama Francis
DIME Sample ID: 2026-03-17-17
TL Number from the TL Form:
Sample Submitted By Organization: Pro-Cast Products, Incorporated - Highland
Sample Organization Contact: (909) 793-7602
Type of Sample: Quality Control
Type of Material: Precast Concrete
Sample Taken Date: 03/17/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/18/2026
The quantity of what the sample constitutes: 5 cy
A brief description of the sample: Ready Mix Concrete
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pro-Cast Products, Inc.
The concrete mix design number: 7F6K40CE
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 2000174
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Ready Mix Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
