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.: Sai Kasaraneni
DIME Sample ID: 2026-08-10-83
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Cement Testing Laboratory
Sample Organization Contact: (916) 227-7071
Type of Sample: Quality Assurance
Type of Material: Cementitious
Sample Taken Date: 08/10/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/10/2026
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Ground Anchor Grout
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Fergusen Slide
The fabricator/manufacturer/facility name: Job Specific Blend
