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: 2026-07-09-133
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Diamond Bar Construction Field Office
Sample Organization Contact: (909) 270-1686
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 07/09/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/09/2026
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: Robertsons-pomona
The concrete mix design number: RRM23086
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 2043503
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
