Sample Record for 2023-11-16-36
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 210409 DEA: 08432724 EFIS: 0800020178
QA Service Level: 2
DIST-CO-RTE-PM: 08-RIV-8-RIV-15-6.4/9.7
Work Description: Collector/distributor system, new on-ramps, bridges, RW, sound walls, drainage, signal and lighting, signage, freeway widening
Location Description: I-15 from Winchester Road to I-215 Junction in Temecula
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Mike Bergevin Structure Rep.: Arnel Vega
Sample Information
DIME Sample ID: 2023-11-16-36
TL Number from the TL Form:
Sample Submitted By Organization: Surecast West
Sample Organization Contact: (951) 491-9506
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 11/16/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/16/2023
The quantity of what the sample constitutes: 10.25 cy
A brief description of the sample: TYPE II/V
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CEMEX-REDLANDS
Material Information
The concrete mix design number: 1610974
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 30983167
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete sample from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
