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: 2026-02-05-15
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: 02/05/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/06/2026
The quantity of what the sample constitutes: 4(6x12 cylinders
A brief description of the sample: Head wall Bishop Pavement B-1 drainage
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name: B-1 drainage headwall
The fabricator/manufacturer/facility name: 7-11 Materials Bishop
The concrete mix design number: 851456A6
The truck number from where the sample was collected: 83993
The batch plant ticket number from where the sample was collected: 956723
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: From truck at b-1 drainage
Where the material sample would have been placed if not sampled: Headwall
From Lot No.:
Bag Lot No.:
