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: 2026-09-10-45
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3675 - Fresno 2
Sample Organization Contact: (559) 304-3318
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 09/10/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/11/2026
The quantity of what the sample constitutes: 111 CY
A brief description of the sample: 6.28SK 1 AGG FA CLASSII
From where was the sample collected: Job Site
Laboratory sample identification: 20260911
Structure unique identifier: 46-E0019
Structure name: RETAINING WALL 9
The fabricator/manufacturer/facility name: Viking Ready Mix Visalia Shirk Rd
The concrete mix design number: ND10531
The truck number from where the sample was collected: 9157
The batch plant ticket number from where the sample was collected: 116237368
Concrete batch plant: 116
The fabricator/manufacturer designation for the sample: mix
A detailed description of where the material sample was collected: Concrete sample from wheel barrel
Where the material sample would have been placed if not sampled: retaining wall stem
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