Sample Record for 2026-06-24-18
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001197 DEA: 07319604 EFIS: 0716000025
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-1,101-21.3/21.9,R34.9/R36.1
Work Description: REMOVE AND CONSTRUCT BRIDGE.
Location Description: VENTURA COUNTY ON ROUTE 1 FROM 1.8 MILES NORTH OF ROUTE 1/33 SEPARATION TO 2.0 MILES SOUTH OF A LEASE CANYON ROAD AND ON ROUTE 101 FROM 0.4 MILE NORTH OF DULAH ROAD UNDERCROSSING TO SAN MIGUELITO ROAD UNDERCROSSING
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 BRISTOL STREET, SUITE D204, COSTA MESA, CA 92626
Resident Engineer: Ranjit Singh Structure Rep.: Aziz Maghsoudloo
Sample Information
DIME Sample ID: 2026-06-24-18
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Quality Assurance
Type of Material: Precast Concrete
Sample Taken Date: 06/24/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/25/2026
The quantity of what the sample constitutes: 10 CY
A brief description of the sample: set of three 4x8 cylinders
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: SSC-ASH25-SF07-9.22-FC6K REV01
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 345
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: Voided Slab - Mark VS-03
From Lot No.:
Bag Lot No.:
Test Results
