Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995124 DEA: 060X3004 EFIS: 0618000051
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-33-69.4/71.5
Work Description: REPLACE ROADWAY PAVEMENT.
Location Description: FRESNO COUNTY IN AND NEAR FIREBAUGH FROM MORRIS KYLE DRIVE TO LYON AVENUE
Contractor Name: BAY CITIES PAVING & GRADING, INC.
Contractor Address: 1450 Civic Court, Building B. #400, Concord, CA 94524
Resident Engineer: Din Dadawalla Structure Rep.: Luis Guzman
DIME Sample ID: 2024-11-13-24
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 11/13/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/13/2024
The quantity of what the sample constitutes: 5 gal bucket
A brief description of the sample: Soil for Subgrade.
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bay Cities
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: STA 131+00 - 142+49
Where the material sample would have been placed if not sampled:
