Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215420 DEA: 060R2104 EFIS: 0614000058
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD-41-6.2/9.2
Work Description: FOR CONSTRUCTION ON STATE HIGHWAY IN MADERA COUNTY NEAR MADERA FROM 0.1 MILE NORTH OF AVENUE 15 TO 2.2 MILES NORTH OF FRIANT MADERA CANAL BRIDGE
Location Description: MADERA COUNTY NEAR MADERA FROM 0.1 MILE NORTH OF AVENUE 15 TO 2.2 MILES NORTH OF FRIANT MADERA CANAL BRIDGE
Contractor Name: CAL VALLEY CONSTRUCTION
Contractor Address: 5125 N. Gates Ave, Ste 102, Fresno, CA 93722
Resident Engineer: Ryan Wilson Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2024-06-10-20
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 06/10/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/10/2024
The quantity of what the sample constitutes: 1 Bucket
A brief description of the sample: Native Back Fill
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cal Valley Construction
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: NB MVP STA 454+00 - 456+58
Where the material sample would have been placed if not sampled:
