Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001444 DEA: 11430314 EFIS: 1118000095
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-67-R4.1/15.9
Work Description: CULVERT RESTORATION, REPLACE SIGNS, ADA CURB RAMPS, AND LED LIGHTING.
Location Description: SAN DIEGO COUNTY FROM 0.2 MILE NORTH OF RIVERFORD ROAD AT LAKESIDE TO ELLIE LANE IN POWAY
Contractor Name: HAZARD CONSRUCTION ENGR, LLC
Contractor Address: 10529 Vine street, Lakeside CA, 92040
Resident Engineer: Sultan Ghazialam Structure Rep.: Unknown
DIME Sample ID: 2026-09-10-72
TL Number from the TL Form:
Sample Submitted By Organization: OldCastle Precast, Incorporated - Fontana
Sample Organization Contact: (951) 396-0214
Type of Sample: Quality Control
Type of Material: Precast Concrete
Sample Taken Date: 09/10/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 9 cylinders
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Oldcastle Infrastructure Fontana
The concrete mix design number: UV-313B(Rev1)
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 86761
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Batch Plant
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
