Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001195 DEA: 060Q5204 EFIS: 0613000190
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-168-48.2
Work Description: PLACE CONCRETE BARRIER AND STRUCTURAL CONCRETE BARRIER SLAB (SHAVER LAKE CONCRETE BARRIER RAIL UPGRADE).
Location Description: ON STATE HIGHWAY IN FRESNO COUNTY NEAR SHAVER LAKE AT STEVENSON CREEK.
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 2716 granitecourt, fresno CA, 93706
Resident Engineer: Mohammed Alqutami Structure Rep.: Martin Garcia
DIME Sample ID: 2025-10-31-5
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: Hot Mix Asphalt
Sample Taken Date: 10/31/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/31/2025
The quantity of what the sample constitutes: 50 Tons
A brief description of the sample: 3/4 HMA - WMA
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Ashlan
