Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001955 DEA: 061H6904 EFIS: 0625000252 COOP: NONE
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-190-42.75
Work Description: Install Sidehill Viaduct (Bridge No. 46-0285).
Location Description:
Contractor Name: CCFG Construction (Michael Niven)
Contractor Address: 17750 Wards Ferry Road, Sonora, CA 95370
Resident Engineer: Cesar Mandujano Structure Rep.: Ye Yang
DIME Sample ID: 2026-04-09-14
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/09/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 26CY
A brief description of the sample: Concrete Backfill Soldier Pile Wall
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CALPORTLAND
The concrete mix design number: 163459D
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 1
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
