Sample Record for 2025-10-20-74
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995494 DEA: 081K4904 EFIS: 0819000050
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-R105.1/R105.9
Work Description: BUILDING WORK, HMA, AND TEMPORARY PORTABLE SANITARY FACILITIES.
Location Description: SAN BERNARDINO COUNTY ABOUT 36 MILES WEST OF NEEDLES FROM 2.1 MILES TO 1.3 MILES WEST OF GOFFS ROAD UNDERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 38000 Monroe Street, Indio, CA 92203
Resident Engineer: Anthony Doan Structure Rep.: Alejandrino Naime
Sample Information
DIME Sample ID: 2025-10-20-74
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 10/20/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/21/2025
The quantity of what the sample constitutes: 1 per batch
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Hi-Grade - Twentynine Palms
Material Information
The concrete mix design number: CT752F25
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 34004862
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Pump house footing, WB and EB MSB/Generator pads.
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
