Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000710 DEA: 100P9244 EFIS: 1023000226
QA Service Level: 1
DIST-CO-RTE-PM: 10-MPA-140-42.0/42.7
Work Description: Fergusen Slide Rock Avalanche Shed
Location Description: Mariposa County, along Route 140 in the Merced River canyon, about 8 miles east of Briceburg and 7.6 miles west of El Portal.
Contractor Name: Myers and Sons Construction, LLC/Ralph L. Wadsworth
Contractor Address: 2554 Millcreek Drive, Sacramento, CA 95833
Resident Engineer: Jonathan Ngai Structure Rep.: Natasha Collins
DIME Sample ID: 2026-08-21-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM6 - Steel Check Sample Plate
Sample Taken Date: 08/21/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/21/2026
The quantity of what the sample constitutes: 7
A brief description of the sample: 16" dia pipe-12" sample
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Arctic Pipe Inspection
Heat Number(s): A43410, C48304, MA4207, MA5596, MA5597, S6136
Material Specification: N/A
Grade: Q125
Thickness: 0.656
Shape: round
Metal Foundry Manufacturer (Mill): USS Tubular Products
Plate Dimension: 16" diameter
