Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993141 DEA: 060V1204 EFIS: 0616000207
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD-99-R6.9/R7.6
Work Description: Cottonwood Creek Bridge Replacement - REPLACE BRIDGES AND CONSTRUCT RETAINING WALLS.
Location Description: MADERA COUNTY NEAR MADERA FROM 0.4 MILE SOUTH OF COTTONWOOD CREEK BRIDGE TO 0.1 MILE NORTH OF AVENUE 12 OVERCROSSING
Contractor Name: Security Paving Company, Inc.
Contractor Address: 3075 Townsgate Road, Westlake Village CA 91361
Resident Engineer: Din Dadawalla Structure Rep.: Ye Yang
DIME Sample ID: 2024-09-30-37
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: Soil
Sample Taken Date: 09/30/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/30/2024
The quantity of what the sample constitutes: Material placed for SBF at Abutment #4
A brief description of the sample: Soil for structure backfill.
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Collected at jobsite
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Sampled from Cal 231 compaction test locations
Where the material sample would have been placed if not sampled:
