Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993493 DEA: 100Q1224 EFIS: 1014000168
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-99-28.2/R37.3
Work Description: WIDEN CONCRETE PAVEMENT LANES AND BRIDGES.
Location Description: MERCED COUNTY IN AND NEAR LIVINGSTON FROM 0.8 MILE SOUTH OF HAMMATT AVENUE OVERCROSSING TO STANISLAUS COUNTY LINE
Contractor Name: SECURITY PAVING COMPANY, INC. - Bassel Jamaleddine
Contractor Address: 3075 Townsgate Rd. Suite 200, Westlake Village CA 91361
Resident Engineer: Tofael Anwar Structure Rep.: Karen Sampson
DIME Sample ID: 2023-01-06-9
TL Number from the TL Form: Cherokee Field Lab 401
Sample Submitted By Organization: CT D10 - Stockton Field Laboratory
Sample Organization Contact: (559) 230-3109
Type of Sample: Department Acceptance
Type of Material: Aggregate
Sample Taken Date: 01/06/2023
Date that the sample was received by the laboratory/organization performing the testing: 01/09/2023
The quantity of what the sample constitutes: Sufficient
A brief description of the sample: 1x4, 3/8" and sand collected
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name: Concrete Trial batch
The fabricator/manufacturer/facility name: Builders Concrete Plant - Merced
Source Identification (SMARA, name of Pit or Job Site): Teichert Santa Fe Winton
The fabricator's/manufacturer's product name for the sample: Teichert Santa Fe - Winton
The fabricator/manufacturer designation for the sample: Trial Batch Structural Concrete
The plant number: teichert Winton
A detailed description of where the material sample was collected: Collected from stockpile
Where the material sample would have been placed if not sampled: Bridge Deck
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: ND14505
Lot number:
Sublot number:
Aggregate Mix Number:
