Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993490 DEA: 051M4604 EFIS: 0519000154
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-1-44.5
Work Description: CONSTRUCT RETAINING WALL, WIDENING SHOULDER AND PLACE HMA. Highway 1 at Coastlands Rd Soldier Pile Wall.
Location Description: MONTEREY COUNTY NEAR BIG SUR AT 1.0 MILE SOUTH OF PFEIFFER CANYON BRIDGE
Contractor Name: FEC Future Contractors & Engineers, Inc
Contractor Address: 184 Technology Dr., Ste 2, Irvine, CA 92618
Resident Engineer: Arashdeep Pannu Structure Rep.: Alex Naime
DIME Sample ID: 2023-01-27-15
TL Number from the TL Form: 213675
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 01/27/2023
Date that the sample was received by the laboratory/organization performing the testing: 01/31/2023
The quantity of what the sample constitutes: 3-4x8
A brief description of the sample: Concrete Samples
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Coastlands Wall 1
The fabricator/manufacturer/facility name: Granite Rock
The concrete mix design number: 572590R
The truck number from where the sample was collected: 2427
The batch plant ticket number from where the sample was collected: 185904
Concrete batch plant: GR Sand City
The fabricator/manufacturer designation for the sample: 341
A detailed description of where the material sample was collected: CHUTE FROM TRUCK
Where the material sample would have been placed if not sampled: Crash Cushion Pad
From Lot No.:
Bag Lot No.:
