Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995239 DEA: 060W9104 EFIS: 0618000011
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-27.6/30.6
Work Description: HMA, RHMA-G, JOINTED PLAIN CONC PVMT (RSC) AND STBB (TYPE M).
Location Description: TULARE COUNTY IN AND NEAR TULARE FROM PAIGE AVENUE OVERCROSSING TO PROSPERITY AVENUE OVERCROSSING.
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Amir Zamanian Structure Rep.: Albert Heredia
DIME Sample ID: 2025-06-18-34
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: 06/18/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/18/2025
The quantity of what the sample constitutes: 10 Boxes
A brief description of the sample: HMA Type A
From where was the sample collected: Source
Laboratory sample identification: L1SL61
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: MMV - Visalia
