Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995451 DEA: 080R8014 EFIS: 0820000075
QA Service Level: 2
DIST-CO-RTE-PM: 08-SBD-15-0/12
Work Description: Construction of one to two HOT lanes in each direction on Interstate 15 between SBD/RIV County Line to Foothill Blvd
Location Description: Interstate 15 between SBD/RIV County Line to Foothill Blvd
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Vicente Bunyi Structure Rep.: Irma Ulloa
DIME Sample ID: 2025-08-22-103
TL Number from the TL Form:
Sample Submitted By Organization: Pinnacle Prestress, Incorporated
Sample Organization Contact: 6616431412
Type of Sample: Quality Control
Type of Material: Precast Concrete
Sample Taken Date: 08/22/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 64 Cy
A brief description of the sample: Precast concrete
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pinnacle Prestress, Inc.
The concrete mix design number: SCC-NFA-9.84-FC8K 060425A
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 16969
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete in wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
