Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993551 DEA: 07279124 EFIS: 0715000076 Permit Numbers: 0722AOP1645
QA Service Level: 2
DIST-CO-RTE-PM: 07-LA-57-60-R4.3/R4.5
Work Description: STATE ROUTE 57 and 60 HIGHWAYS CONFLUENCE CHOKEPOINT RELIEF PROJECT PHASE II
Location Description: CITY of DIAMOND BAR and CITY of INDUSTRY LOS ANGELES COUNTY, CALIFORNIA
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Thomas Tong
DIME Sample ID: 2026-08-26-7
TL Number from the TL Form:
Sample Submitted By Organization: Caltrans IA
Sample Organization Contact: (916) 240-3821
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 08/26/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/09/2026
The quantity of what the sample constitutes: Multiple Lanes
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Robertson mix
The concrete mix design number: RRM 22127
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 1592903
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Bin
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2026-08-26-7-1
Test Method: CTM 342C-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 09/09/2026
Date Tested: 09/09/2026
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (213) 792-4797
General Comments for this Test: Ave. .37
Test Result Compliance: complies
Additional Comments When Verified:
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Pavement or Bridge Deck?
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Pavement
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