Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994873 DEA: 060X7804 EFIS: 0618000138
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-41-R23.2/R31.7
Work Description: CONSTRUCT SLOPE PAVING, ROCK BLANKET AND STAMPED CONCRETE.
Location Description: FRESNO COUNTY IN FRESNO AT VARIOUS LOCATIONS FROM VENTURA AVENUE VIADUCT TO FRIANT ROAD UNDERCROSSING
Contractor Name: IBARRA GENERAL ENGINEERING INC
Contractor Address: 4325 Tyrolite Street, Riverside, CA 92509
Resident Engineer: Gashu Equanhone Structure Rep.: Unknown
DIME Sample ID: 2024-10-31-21
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: Concrete
Sample Taken Date: 10/31/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/31/2024
The quantity of what the sample constitutes: 6 cylinders
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ibarra general engineering inc
The concrete mix design number: 163457
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 212901
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: chute from concrete truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
