Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994884 DEA: 061A3204 EFIS: 0619000233
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-180-R62.9/R65.3
Work Description:
Location Description:
Contractor Name: CAL VALLEY CONSTRUCTION
Contractor Address: 5125 N. Gates Ave, Ste 102, Fresno, CA 93722
Resident Engineer: Chris Wilfong Structure Rep.: Unknown
DIME Sample ID: 2023-08-06-5
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 08/06/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/06/2023
The quantity of what the sample constitutes: 815 Tons
A brief description of the sample: Coldfeed
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name: Hwy 180
The fabricator/manufacturer/facility name: Vulcan Ashlan
Source Identification (SMARA, name of Pit or Job Site): 91-20-0016
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Cold Feed Sampling Chute
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number: 1
Sublot number: 2
Aggregate Mix Number:
