Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215349 DEA: 081C0824 EFIS: 0816000087
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R104.9/R134.2
Work Description: PLACE HMA (TYPE A), JPCP AND IMPORTED BORROW.
Location Description: RIVERSIDE COUNTY FROM ROUTE 10/177 SEPARATION TO 1.1 MILES WEST OF WILEY'S WELL RD OC
Contractor Name: FISHER SAND & GRAVEL CO.
Contractor Address: 1302 W DRIVERS WAY, TEMPE, AZ. 85284
Resident Engineer: Khoi Vu Structure Rep.: Shukri Abouazra
DIME Sample ID: 2022-10-17-12
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 10/17/2022
Date that the sample was received by the laboratory/organization performing the testing: 10/18/2022
The quantity of what the sample constitutes: 1
A brief description of the sample: Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Coffman Specialties, Inc
The concrete mix design number: RRM1114
The truck number from where the sample was collected: 1
The batch plant ticket number from where the sample was collected: 12
Concrete batch plant: FDL
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Field
Where the material sample would have been placed if not sampled: Road
From Lot No.: 1
Bag Lot No.: 2
DIME Test ID: 2022-10-17-12-1
Test Method: ASTM C39-10: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
Capped in accordance with ASTM C1231 - Unbonded Elastomeric Pad Cap Cured in accordance with ASTM C511
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 407-6963
Data has not been verified.
