Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002077 DEA: 033H5904 EFIS: 0318000017
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-80-R26.3/R55.2
Work Description:
Location Description:
Contractor Name: Flatiron Dragados/Teichert
Contractor Address: 555 S Auburn St, Colfax, CA 95713
Resident Engineer: John Ruzic Structure Rep.: Carl Anderson
DIME Sample ID: 2026-10-13-8
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California Corporation - Lathrop
Sample Organization Contact: (209) 249-4700
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 10/13/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/23/2026
The quantity of what the sample constitutes: 1 cubic ft. of Concrete for Testing
A brief description of the sample: Bed 5, Middle of Truck 3
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Con-Fab California, LLC - Lathrop
The concrete mix design number: L_98V25-A6
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 3564
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Bed 5, Middle of Truck 4
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2026-10-13-8-1
Test Method: ASTM C1064-17: Standard Test Method for Temperature of Freshly Mixed Hydraulic-Cement Concrete
Submitted By Organization: Con-Fab California Corporation - Lathrop
Organization Address: 1910 Lathrop Road,
Organization City: Lathrop
Organization State: CA
Organization Zipcode: 95330
Organization Email: jerryx@confabca.com
Organization Phone: (408) 466-5557
Data has not been verified.
