Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000511 DEA: 06487404 EFIS: 0616000029
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-35.8/37.1
Work Description: Caldwell Interchange SR99/Ave280 (Visalia) - Replace Bridge Structures and Construct Roundabouts.
Location Description: TULARE COUNTY IN AND NEAR VISALIA FROM 0.6 MILE SOUTH OF AVENUE 280 OVERCROSSING TO 0.7 MILE NORTH OF AVENUE 280 OVERCROSSING
Contractor Name: Granite Construction Company (Karen Cervantes)
Contractor Address: 2716 Granite Court, Fresno, CA 93706
Resident Engineer: Alberto Lopez Structure Rep.: Martin Garcia
DIME Sample ID: 2026-09-02-22
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3675 - Monterey, Santa Cruz, San Benito
Sample Organization Contact: (805) 471-2109
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/02/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 48 CY
A brief description of the sample: CIDH RW 6 Pour day 1
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CalPortland
The concrete mix design number: 275459W
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 309891
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: RW 6 day 2 pour
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
