Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993121 DEA: 032H62U4 EFIS: 0319000021
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV-20-25.6/39.8
Work Description: ROADWAY EXCAVATION, HMA (TYPE A) WITH CLASS 2 AB, RCB CULVERT AND RCP.
Location Description: NEVADA COUNTY NEAR OMEGA AT VARIOUS LOCATIONS FROM 0.2 MILE WEST OF CONSERVATION ROAD (WASHINGTON RIDGE ROAD) TO 1.2 MILES WEST OF ZEIBRIGHT ROAD
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: Jeff Johnson Structure Rep.: Unknown
DIME Sample ID: 2022-06-27-56
TL Number from the TL Form:
Sample Submitted By Organization: Precast Unlimited Inc.
Sample Organization Contact: (530) 243-6477
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 06/27/2022
Date that the sample was received by the laboratory/organization performing the testing: 06/27/2022
The quantity of what the sample constitutes: 2
A brief description of the sample: Concrete Cylinder
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Universal Precast Concrete
The concrete mix design number: PC65A0E2
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 27064
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Back of Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
