Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000541 DEA: 09374704 EFIS: 0918000019
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-168,395-17.6/18.3,114.9/117.8
Work Description: HMA (TYPE A), MINOR CONCRETE, AND LIGHTING.
Location Description: INYO COUNTY IN AND NEAR BISHOP ON ROUTE 395 FROM 0.1 MILE SOUTH OF JAY STREET TO BARLOW LANE AND ON ROUTE 168 FROM PIONEER LANE TO ROUTE 395
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: P.O. BOX 2210, PISMO BEACH, CA 93448-2210
Resident Engineer: John Gentry Structure Rep.: Unknown
DIME Sample ID: 2025-12-02-12
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 12/02/2025
Date that the sample was received by the laboratory/organization performing the testing: 12/02/2025
The quantity of what the sample constitutes: 1 bag of native soil/2
A brief description of the sample: Native Soil for Subgrade/2
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Papich Construction
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: sampled from lift
Where the material sample would have been placed if not sampled:
