Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 3448 DEA: 06442614
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-99-26.7/30.6
Work Description: WIDEN FREEWAY AND BRIDGES FROM 4 TO 6 LANES.
Location Description: FRESNO COUNTY IN FRESNO FROM 0.2 MILE NORTH OF ASHLAN AVENUE OVERCROSSING TO 0.1 MILE NORTH OF GRANTLAND AVENUE UNDERCROSSING
Contractor Name: DE SILVA GATES CONSTRUCTION
Contractor Address: P.O. BOX 2909, DUBLIN, CA 94568
Resident Engineer: RAAID ABOUZEDAN Structure Rep.: PETER MOUA
DIME Sample ID: 2025-04-24-42
TL Number from the TL Form:
Sample Submitted By Organization: Structures Maintenance and Investigations
Sample Organization Contact: (916) 719-0108
Type of Sample: Informational
Type of Material: Concrete Core
Sample Taken Date: 04/24/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/05/2025
The quantity of what the sample constitutes: 7
A brief description of the sample: Concrete Cores
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Mt Shasta Separation
The fabricator/manufacturer/facility name: Bridge 02-0091K
