Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000710 DEA: 100P9244 EFIS: 1023000226
QA Service Level: 1
DIST-CO-RTE-PM: 10-MPA-140-42.0/42.7
Work Description: Fergusen Slide Rock Avalanche Shed
Location Description: Mariposa County, along Route 140 in the Merced River canyon, about 8 miles east of Briceburg and 7.6 miles west of El Portal.
Contractor Name: Myers & Sons (SBE)
Contractor Address: 2554 Millcreek Drive, Sacramento, CA 95833
Resident Engineer: Jonathan Ngai Structure Rep.: Natasha Collins
DIME Sample ID: 2026-01-05-1
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Verification
Type of Material: SMTL TM6 - Steel Check Sample Plate
Sample Taken Date: 01/05/2026
Date that the sample was received by the laboratory/organization performing the testing: 01/06/2026
The quantity of what the sample constitutes: 191 A53-B drain pipes
A brief description of the sample: A53-B, 2"x10' perforated and nonperforated pipes
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Fergusen Slide
The fabricator/manufacturer/facility name: Caltrans Construction
Heat Number(s): 280614
Material Specification: N/A
Grade: A53-B
Thickness: 10
Shape: Round
Metal Foundry Manufacturer (Mill): Wheatland possibly
Plate Dimension: 2" x 10" pipe length
