Sample Record for 2026-04-23-38
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000785 DEA: 081J3204 EFIS: 0818000017 COOP: NONE
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-17.8
Work Description: BUILDING WORK, WROUGHT IRON FENCE, HOT MIX ASPHALT, & AGGREGATE BASE.
Location Description: RIVERSIDE COUNTY NEAR LAKE ELSINORE AT LAKE ELSINORE MAINTENANCE STATION AT 18745 CONARD AVENUE
Contractor Name: NATIONWIDE CONTRACTING SERVICES, INC. DBA NATIONWIDE GENERAL CONSTRUCTION SERVICES
Contractor Address: 7660 liberty drive, Huntington beach, CA, 92647
Resident Engineer: Jason Shbaita Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2026-04-23-38
TL Number from the TL Form: 1087-12
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/24/2026
The quantity of what the sample constitutes: 8
A brief description of the sample: CONCRETE CYLINDERS
From where was the sample collected: Job Site
Laboratory sample identification: 1087-12
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NATIONWIDE
Material Information
The concrete mix design number: SC59033
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: CT MAINT FACILITY
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
