Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994084 DEA: 060U8804 EFIS: 0616000074
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-26.3/27.6
Work Description: CONSTRUCT A NEW INTERCHANGE AT COMMERCIAL AVENUE NOW CALLED INTERNATIONAL AGRI-CENTER WAY
Location Description: ON STATE ROUTE 99
Contractor Name: SECURITY PAVING COMPANY INC
Contractor Address: 13170 TELEFAIR AVE, SYLMAR, CA 91342
Resident Engineer: Alberto Lopez Structure Rep.: Vicente Sanchez
DIME Sample ID: 2025-01-22-17
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: Hot Mix Asphalt
Sample Taken Date: 01/22/2025
Date that the sample was received by the laboratory/organization performing the testing: 01/22/2025
The quantity of what the sample constitutes: 10 Boxes 2 Bags 2 Cans
A brief description of the sample: HMA Type A
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta - Visalia
