Sample Record for 2026-01-15-22
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
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
Sample Information
DIME Sample ID: 2026-01-15-22
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 01/15/2026
Date that the sample was received by the laboratory/organization performing the testing: 01/15/2026
The quantity of what the sample constitutes: 6 cylinders
A brief description of the sample: Mix #851456A6
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: 711 materials
Material Information
The concrete mix design number: 851456A6
The truck number from where the sample was collected: 989
The batch plant ticket number from where the sample was collected: 953604
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Noble ditch US 395 northbound headwall
Where the material sample would have been placed if not sampled: Noble ditch headwall
From Lot No.:
Bag Lot No.:
Test Results
