Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001573 DEA: 060X2904 EFIS: 0618000050
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-33-13.9/16.7
Work Description: HMA (TYPE A), RDWY EXC, CL 2 AB, CURB RAMPS AND MOBILIZATION.
Location Description: FRESNO COUNTY IN AND NEAR COALINGA FROM ENTERPRISE PARKWAY TO LOS GATOS CREEK SOUTH CHANNEL BRIDGE
Contractor Name: Cal Valley Construction, Inc. (Chris Grimm)
Contractor Address: Unknown
Resident Engineer: Din Dadawalla Structure Rep.: Unknown
DIME Sample ID: 2026-04-22-34
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: 04/22/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/23/2026
The quantity of what the sample constitutes: 9 4x8 Compression Strength Cylinders
A brief description of the sample: Concrete Placed During Shift
From where was the sample collected: Job Site
Laboratory sample identification: 5
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JJJ Redi-Mix Coalinga
The concrete mix design number: 631000
The truck number from where the sample was collected: J81
The batch plant ticket number from where the sample was collected: 42691
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Location C-42
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
