Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000700 DEA: 07348204 EFIS: 0718000137
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-210-R19.4/R27.0
Work Description: RESTORE BRIDGE AND DRAINAGE SYSTEM, AND CONSTRUCT STAMPED CONCRETE.
Location Description: LOS ANGELES COUNTY IN LA CANADA FLINTRIDGE AND PASADENA AT VARIOUS LOCATIONS FROM 0.1 MILE EAST OF WINERY CANYON FLUME OVERCROSSING TO 0.1 MILE EAST OF HILL AVENUE UNDERCROSSING
Contractor Name: BOSCO CONSTRUCTORS, INC.
Contractor Address: Unknown
Resident Engineer: Danglong Tran Structure Rep.: Unknown
DIME Sample ID: 2026-03-16-86
TL Number from the TL Form:
Sample Submitted By Organization: Thompson Pipe Group - Los Angeles
Sample Organization Contact: (909) 201-5127
Type of Sample: Quality Control
Type of Material: Precast Concrete
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: 2.5 cy
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Thompson pipe group
The concrete mix design number: CT6002PH
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 20007
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Conveyor Belt
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
