Sample Record for 2025-05-06-10
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001165 DEA: 061H6304 EFIS: 0625000097
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-6-43.95
Work Description: The scope of work will include culvert replacement, pavement repair, traffic control, and pavement delineation.
Location Description: Fresno County, Rout I-5 at PM 43.95.
Contractor Name: A. TEICHERT & SON INC DBA TEICHERT CONSTRUCTION
Contractor Address: 5771 S. Toyota Ave, Fresno, CA 93725
Resident Engineer: Mark Mengoni Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2025-05-06-10
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: Aggregate
Sample Taken Date: 05/06/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/06/2025
The quantity of what the sample constitutes: 4cy
A brief description of the sample: Class 2 Aggregate Base
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Coalinga HMA Plant
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-10-0005
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: SB #1 lane
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
