Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000343 DEA: 061E7304 EFIS: 0622000093
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-41-R25.3
Work Description: PREFABRICATED BUILDING, WROUGHT IRON FENCE AND GATE.
Location Description: FRESNO COUNTY IN FRESNO AT MCKINLEY AVENUE
Contractor Name: CALIFORNIA TURF AND LANDSCAPING
Contractor Address: Unknown
Resident Engineer: Fernando De Alba Structure Rep.: Sok Heng Thun
DIME Sample ID: 2025-03-17-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 03/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 03/17/2025
The quantity of what the sample constitutes: Material on site
A brief description of the sample: Baserock
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Jobsite
Source Identification (SMARA, name of Pit or Job Site): Jobsite
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Sampled from stockpile at jobsite
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
