Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994976 DEA: 060X3304 EFIS: 0618000055
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-5-R0.0/4.4
Work Description: REPLACE ROADWAY PAVEMENT WITH HMA AND CONCRETE.
Location Description: KERN COUNTY AT AND NEAR LEBEC FROM LOS ANGELES COUNTY LINE TO GRAPEVINE CREEK
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: Unknown
Resident Engineer: Joy Denny Structure Rep.: Travis Landas
DIME Sample ID: 2024-10-24-84
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Bakersfield Field Laboratory
Sample Organization Contact: 661-549-8281
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 10/24/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/25/2024
The quantity of what the sample constitutes: 600-900 CY
A brief description of the sample: JPCP- cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: SPCI onsite
The concrete mix design number: G3-18-PCC-128R
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 65
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Back of Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
