Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000264 DEA: 060W90U4 EFIS: 0623000128
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-198,216-R11.6/R11.9,R0.0/2.7
Work Description: HMA AND MODIFYING SIGNAL AND LIGHTING SYSTEMS.
Location Description: TULARE COUNTY IN AND NEAR VISALIA ON ROUTE 216 FROM 0.2 MILE SOUTH OF LOVERS LANE UNDERCROSSING TO 0.2 MILE EAST OF MCAULIFF STREET AND ON ROUTE 198 FROM 0.1 MILE WEST TO 0.2 MILE EAST OF LOVERS LANE UNDERCROSSING
Contractor Name: Teichert Construction (James Dunnington)
Contractor Address: 5771 Toyota Avenue, Fresno, CA 93725
Resident Engineer: Chris Wilfong Structure Rep.: Martin Garcia
DIME Sample ID: 2025-07-23-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Control
Type of Material: Precast Concrete
Sample Taken Date: 07/23/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 5 CY
A brief description of the sample: SCC
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: OLD CASTLE PRECAST
The concrete mix design number: 88
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: xxxxxxxx
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Batch Plant
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
