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: 2026-06-26-63
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: 06/26/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/29/2026
The quantity of what the sample constitutes: 180.5
A brief description of the sample: 6.28SK 1AGG FA CLASS II
From where was the sample collected: Job Site
Laboratory sample identification: 2026-06-26
Structure unique identifier:
Structure name: RETAINING WALL 10
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: 9231
The batch plant ticket number from where the sample was collected: 116235143
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 Footing
From Lot No.:
Bag Lot No.:
