Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994820 DEA: 060V1104 EFIS: 0616000208
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE,KIN-5,41,198-Var
Work Description: STRATFORD KINGS RIVER BRIDGE REPLACEMENT.
Location Description: FRESNO AND KINGS COUNTIES AT VARIOUS LOCATIONS
Contractor Name: M.C.M. Construction, INC. (Richard McCall)
Contractor Address: 6413 32nd Street, North Highlands, Ca 95660
Resident Engineer: Din Dadawalla Structure Rep.: Martin Garcia
DIME Sample ID: 2024-03-27-89
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California, LLC
Sample Organization Contact: (661) 630-7162
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 03/27/2024
Date that the sample was received by the laboratory/organization performing the testing: 03/27/2024
The quantity of what the sample constitutes: 1 Bucket of 1/2", 1 Bucket of 3/8", One Bucket of Sand
A brief description of the sample: 1 Bucket of 1/2", 1 Bucket of 3/8", One Bucket of Sand
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Con-Fab California, LLC - Shafter
Source Identification (SMARA, name of Pit or Job Site): Con-Fab California, LLC
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: Stockpile at the Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
