Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001867 DEA: 061J3304 EFIS: 0626000065
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-41-Var
Work Description: Fence repairs for encampment mitigation
Location Description: Hwy 41 in Fresno
Contractor Name: Al Var Fence Co. (Albert Vargas)
Contractor Address: Unknown
Resident Engineer: Alaa Ghoneim Structure Rep.: Unknown
DIME Sample ID: 2026-04-29-33
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: Concrete
Sample Taken Date: 04/29/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/29/2026
The quantity of what the sample constitutes: 4 cy
A brief description of the sample: 3 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Alvar Fenco co
The concrete mix design number: quikcrete bags (50lb)
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: hwy 180 / Blackstone
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
