Sample Record for 2026-06-22-83
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.: Al Alina AlHakem
Sample Information
DIME Sample ID: 2026-06-22-83
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9098293350
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 06/22/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/22/2026
The quantity of what the sample constitutes: 29076
A brief description of the sample: Native Material
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NATIONWIDE
Material Information
Source Identification (SMARA, name of Pit or Job Site): Native Driveway
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Caltrans Maintenance Station, Lake Elsinore
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: mineral filler
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
