Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001614 DEA: 060X0704 EFIS: 0618000016
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-245-0.0/33.0
Work Description: REMOVE AND REPLACE CSP AND RCP CULVERTS.
Location Description: TULARE COUNTY AT VARIOUS LOCATIONS FROM ROUTE 198/245 SEPARATION TO FRESNO COUNTY LINE
Contractor Name: Genuine Engineering Inc (Trever Shiplee)
Contractor Address: 11762 De Palma Road,Suite 1C, PMB 225, Corona, CA 92883
Resident Engineer: Javier Huerta Structure Rep.: none none
DIME Sample ID: 2025-08-20-137
TL Number from the TL Form:
Sample Submitted By Organization: Thompson Pipe Group - Los Angeles
Sample Organization Contact: (909) 201-5127
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 08/20/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/20/2025
The quantity of what the sample constitutes: 2.5 cy
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: thompson pipe group
The concrete mix design number: ct6002ph
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 13063
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: conveyor belt
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
