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: 2025-08-28-13
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 08/28/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/29/2025
The quantity of what the sample constitutes: 68 cy
A brief description of the sample: Retaining wall concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Loverslane
The fabricator/manufacturer/facility name: Calportland
The concrete mix design number: 172457
The truck number from where the sample was collected: 1790
The batch plant ticket number from where the sample was collected: 252929
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
