Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000062 DEA: 061F8204 EFIS: 0623000100
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-168-39.6/45.7
Work Description: COLD PLANE AC PVMT, HMA (TYPE A), PAINT TRAFFIC STRIPES.
Location Description: FRESNO COUNTY IN AND NEAR SHAVER LAKE FROM 0.2 MILE WEST OF CRESSMAN ROAD TO WARBLER ROAD
Contractor Name: AGEE CONSTRUCTION CORPORATION
Contractor Address: 1039 Hoblitt Avenue, Clovis, CA 93612
Resident Engineer: Jesse Carpenter Structure Rep.: Unknown
DIME Sample ID: 2024-09-23-2
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 417-5341
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/23/2024
The quantity of what the sample constitutes: 125 Tons
A brief description of the sample: 3/4 HMA sp
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Ashlan
