Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001028 DEA: 07317804 EFIS: 0715000274 COOP: 075065
QA Service Level: 2
DIST-CO-RTE-PM: 07-VEN-34-6.3
Work Description: Construct grade separation structure and connector ramps
Location Description: SR34 and Rice Avenue, Oxnard
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Azizollah Maghsoudloo
DIME Sample ID: 2026-03-16-67
TL Number from the TL Form:
Sample Submitted By Organization: Surecast West
Sample Organization Contact: (951) 491-9506
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 03/16/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/17/2026
The quantity of what the sample constitutes: 10.00 CY
A brief description of the sample: TYPE II /V
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CEMEX -REDLANDS
The concrete mix design number: 1610974
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 31925208
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: CONCRETE SAMPLE FROM WHEELBARROW
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2026-03-16-67-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Verified Date: 03/26/2026
Date Tested: 03/16/2026
Submitted By Organization: Surecast West
Organization Address: 8203 Alabama Street,
Organization City: Redlands
Organization State: CA
Organization Zipcode: 92373
Organization Email: cody@surecastwest.com
Organization Phone: (951) 491-9506
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2026-03-16-67-3
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 03/26/2026
Date Tested: 03/16/2026
Submitted By Organization: Surecast West
Organization Address: 8203 Alabama Street,
Organization City: Redlands
Organization State: CA
Organization Zipcode: 92373
Organization Email: cody@surecastwest.com
Organization Phone: (951) 491-9506
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
