Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001574 DEA: 060X4304 EFIS: 0618000065 COOP: NONE
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-5725--
Work Description: TREE CREW AND SPECIAL CREWS BUILDING.
Location Description: FRESNO COUNTY IN FRESNO AT WEST AVENUE MAINTENANCE STATION AT 1283 NORTH WEST AVENUE
Contractor Name: Bowe Contractors, Inc. (Greg Willcutt)
Contractor Address: 609 Bailey Court, Tehachapi, CA 93561
Resident Engineer: Mohammed Alqutami Structure Rep.: Sok Heng Thun
DIME Sample ID: 2026-04-24-17
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 04/24/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/24/2026
The quantity of what the sample constitutes: 5 gal bucket
A brief description of the sample: Native Soil for Subgrade
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: BCI
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: CT Special crews yard, elevation. 290.0
Where the material sample would have been placed if not sampled:
