Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993815 DEA: 081C0814 EFIS: 0816000086
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R60.7/R74.3
Work Description: I-10 PAVEMENT REHABILITATION (SEGMENT 1) PROJECT
Location Description: Coachella
Contractor Name: COFFMAN SPECIALTIES, INC
Contractor Address: 4375 JUTLAND DRIVE STE 260, SAN DIEGO CA 92117
Resident Engineer: Michael Sergah Structure Rep.: Al Alina
DIME Sample ID: 2024-01-25-13
TL Number from the TL Form: 1051-74
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 01/25/2024
Date that the sample was received by the laboratory/organization performing the testing: 01/26/2024
The quantity of what the sample constitutes: 3
A brief description of the sample: Concrete Cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 1051-74
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
The concrete mix design number: CT675F25D
The truck number from where the sample was collected: 261
The batch plant ticket number from where the sample was collected: 916433
Concrete batch plant: NA
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: SMOKY GULCH BRIDGE
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-01-25-13-1
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 D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
Data has not been verified.
