Sample Record for 2026-04-16-10
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001248 DEA: 120K93U4 EFIS: 1224000084
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-57,91-13.9/16.1,4.8/6.6
Work Description: CONST BRIDGES, RW, SW, PAVEMENT, DRAINAGE AND ELECTRICAL SYSTEMS.
Location Description: ANAHEIM AND PLACENTIA ON ROUTE 57 FROM WAGNER AVENUE OVERCROSSING TO 0.2 MILE NORTH OF MIRALOMA AVENUE OVERCROSSING AND ON ROUTE 91 FROM 0.1 MILE EAST OF ACACIA STREET UNDERCROSSING TO 0.2 MILE EAST OF LA PALMA AVENUE OVERCROSSING
Contractor Name: OHLA USA, INC
Contractor Address: 2550 East Miraloma Way, Suite 200, Anaheim, CA 92806
Resident Engineer: Charlie Nakamoto Structure Rep.: Tien Chu
Sample Information
DIME Sample ID: 2026-04-16-10
TL Number from the TL Form:
Sample Submitted By Organization: Pinnacle Prestress, Incorporated
Sample Organization Contact: 6616431412
Type of Sample: Quality Control
Type of Material: Precast Concrete
Sample Taken Date: 04/16/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/16/2026
The quantity of what the sample constitutes: 34 CY
A brief description of the sample: Concrete in a wheelbarrow
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pinnacle Prestress, Inc.
Material Information
The concrete mix design number: CON-NFA-8.00-FC7K REV 0316226A
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 0018266
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.:
Test Results
