Sample Record for 2024-10-08-18
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995005 DEA: 060X7004 EFIS: 0619000009
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-63-5.8/L8.0
Work Description: COLD PLANE PAVEMENT, PLACE RHMA-G, MODIFY LIGHTING AND SIGNAL SYSTEM.
Location Description: TULARE COUNTY IN VISALIA FROM 0.2 MILE SOUTH OF CALDWELL AVENUE TO ROUTE 63/198 SEPARATION
Contractor Name: CAL VALLEY CONSTRUCTION, INC. (Angel Sandoval & Chris Grimm)
Contractor Address: 5125 N. Gates Ave, Suite 102, Fresno, CA 93722
Resident Engineer: Cesar Mandujano Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2024-10-08-18
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Visalia Field Laboratory
Sample Organization Contact: (559) 974-1304
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 10/08/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/09/2024
The quantity of what the sample constitutes: 10 Box, 4 Bag, 2 Can
A brief description of the sample: 1/2 HMA Type A
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Deer Creek Rock and Aspahlt
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-54-0021
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: HMA Plant Cold Feed
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number: 1
Sublot number: 8
Aggregate Mix Number:
Test Results
