Sample Record for 2026-08-05-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994415 DEA: 120R3114 EFIS: 1220000021
QA Service Level: 1
DIST-CO-RTE-PM: 12-LA,ORA-91-R20.6/R20.7,R0.0/4.8
Work Description: PLACE JPCP (RSC) AND RHMA, AND MODIFY ELECTRICAL SYSTEMS.
Location Description: LOS ANGELES AND ORANGE COUNTIES FROM 0.1 MILE WEST OF THE LOS ANGLES COUNTY LINE IN CERRITOS TO 0.1 MILE EAST OF ACACIA STREET UNDERCROSSING IN ANAHEIM
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Bill Gilchrist Structure Rep.: Mahesh Kapoor
Sample Information
DIME Sample ID: 2026-08-05-6
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 08/05/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 116 CY
A brief description of the sample: PCC
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Orange
Material Information
The concrete mix design number: 1614705
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: Unknown
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Discharge from concrete truck chute
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
