Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215050 DEA: 080R1424 EFIS: 0815000201
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-R125.0/R154.6
Work Description: ROADWAY EXCAVATION, IMPORT BORROW AND REGRADE THE MEDIAN SLOPE.
Location Description: SAN BERNARDINO COUNTY FROM 4.5 MILES EAST OF HOMER WASH BRIDGE TO ARIZONA STATE LINE
Contractor Name: Ames Construction
Contractor Address: 391 N. MAIN STREET, CORONA CA 92880
Resident Engineer: Darcy Davis Structure Rep.: Unknown
DIME Sample ID: 2022-02-24-17
TL Number from the TL Form: 1035-1
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: 02/24/2022
Date that the sample was received by the laboratory/organization performing the testing: 03/10/2022
The quantity of what the sample constitutes: 2
A brief description of the sample: Concrete Cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 1035-1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
The concrete mix design number: 1619144
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: not provided
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: I40 DS12 Head Wall Footing Sta 4501-70
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-02-24-17-1
Test Method: ASTM C39-21: Standard Test Method for Compressive Strength of Cylindrical Concrete Specimens
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: 9098293029
Data has not been verified.
