Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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
DIME Sample ID: 2024-10-09-82
TL Number from the TL Form: 06-0X7004
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Verification
Type of Material: Asphaltic Emulsion
Sample Taken Date: 10/09/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2024
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: SS1H 100%
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TALLY OIL INC
