Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000207 DEA: 060Q4324 EFIS: 0619000026 COOP: 061730
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-190-13.1/16.6
Work Description: HMA, MINOR CONCRETE AND JPCP.
Location Description: TULARE COUNTY IN AND NEAR PORTERVILLE AT VARIOUS LOCATIONS FROM 0.2 MILE WEST OF WESTWOOD STREET TO 0.1 MILE EAST OF SOUTH MAIN STREET
Contractor Name: CAL VALLEY CONSTRUCTION, INC.
Contractor Address: 5125 North Gates Avenue, Suite 102, Fresno CA 93722
Resident Engineer: Tyler Street Structure Rep.: Vicente Sanchez
DIME Sample ID: 2026-04-23-59
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: No Test
Type of Material: Asphaltic Emulsion
Sample Taken Date: 04/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/18/2026
The quantity of what the sample constitutes: 1 JUG OF EMULSION
A brief description of the sample: SS-1H
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Talley Oil - Madera
