Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000430 DEA: 060Y1804 EFIS: 0619000005 COOP: 061796
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD-145-8.0/12.0
Work Description: Place HMA (Type A), minor concrete sidewalk, lighting (city streets)
Location Description: CONSTRUCTION ON STATE HIGHWAY IN MADERA COUNTY IN AND NEAR MADERA FROM 0.1 MILE SOUTH OF AVENUE 13 TO 0.1 MILE SOUTH OF EAST MADERA UNDERPASS
Contractor Name: Cal Valley Construction, Inc. (Chris Grimm)
Contractor Address: 5125 N Gates Avenue, Fresno, CA 93722
Resident Engineer: Chantha Chap Structure Rep.: None None
DIME Sample ID: 2026-08-18-58
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: 08/18/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/18/2026
The quantity of what the sample constitutes: 5 gal bucket
A brief description of the sample: soil for subgrade
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cal Valley Construction
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: driveway #6 lewis st - denham st
Where the material sample would have been placed if not sampled:
