Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994787 DEA: 061F7004 EFIS: 0623000145
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-4/15.5
Work Description:
Location Description:
Contractor Name: Yarbs Grading and Paving, Inc.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-05-04-40
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Visalia Field Laboratory
Sample Organization Contact: (559) 974-1304
Type of Sample: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/04/2023
The quantity of what the sample constitutes: 312 Ton
A brief description of the sample: 3/4 HMA -A No Rap PG70-10
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Porterville Rock and Recycle PAI
