Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215348 DEA: 060U4204 EFIS: 0616000004
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-99-R4.9/11.6
Work Description: CONSTRUCT CRCP, PLACE HMA, AND ROADWAY EXCAVATION.
Location Description: FRESNO COUNTY IN AND NEAR SELMA AND FOWLER FROM MCCALL AVENUE UNDERCROSSING TO 0.5 MILE NORTH OF MERCED STREET UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3075 Townsgate Rd. Suite 200, Westlake Village CA 91361
Resident Engineer: Chris Wilfong Structure Rep.: Unknown
DIME Sample ID: 2023-01-25-42
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Fresno Field Laboratory
Sample Organization Contact: (559) 383-5498
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 01/25/2023
Date that the sample was received by the laboratory/organization performing the testing: 02/03/2023
The quantity of what the sample constitutes: 293 tons
A brief description of the sample: 3/4" HMA
From where was the sample collected: Source
Laboratory sample identification: 23-A-002
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan, Ashlan
