Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000015 DEA: 033H8304 EFIS: 0318000075
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-49-3.5/7.5
Work Description: CONSTRUCT SIDEWALKS, CURB RAMPS AND DRAINAGE FACILITIES. CONSTRUCT PEDESTRIAN BRIDGE
Location Description: PLACER COUNTY IN AND NEAR AUBURN FROM 0.3 MILE NORTH OF ROUTE 80/49 SEPARATION TO 0.1 MILE NORTH OF DRY CREEK ROAD
Contractor Name: PACIFIC INFRASTRUCTURE CONSTRUCTION, LLC
Contractor Address: 871 COTTING COURT STE A, VACAVILLE CA 95688
Resident Engineer: Lucas Price Structure Rep.: Eric Duray
DIME Sample ID: 2025-06-26-113
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California Corporation - Lathrop
Sample Organization Contact: (209) 249-4700
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 06/26/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/26/2025
The quantity of what the sample constitutes: 1 Bucket of 1/2", 1 Bucket of 3/8", One Bucket of Sand
A brief description of the sample: 1 Bucket of 1/2", 1 Bucket of 3/8", One Bucket of Sand
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ConFab Lathrop
Source Identification (SMARA, name of Pit or Job Site): Confab California Lathrop
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: Stockpile @ Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
