Sample Record for 2026-06-04-100
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001902 DEA: 061H6704 EFIS: 0625000240
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-190-26.65
Work Description: Replace exiting bridge rail on EB direction of SR 190, demo and reconstruct overhang, remove existing AC overlay, deck overhang strengthening at bridge rail, poly conc overlay, install new ST-75 barrier rail.
Location Description: Tule River Bridge (BR #46-0187).
Contractor Name: Chapco Construction (Matthew Clifford)
Contractor Address: 6000 Mortono Street, Sacramento, CA 95828
Resident Engineer: Cesar Mandujano Structure Rep.: Ye Yang
Sample Information
DIME Sample ID: 2026-06-04-100
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: 06/04/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/05/2026
The quantity of what the sample constitutes: 18 cy
A brief description of the sample: Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CALPORTLAND
Material Information
The concrete mix design number: 163459
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 294948
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
