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: 2024-06-18-93
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 417-5341
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 06/18/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/19/2024
The quantity of what the sample constitutes: 1 Bucket
A brief description of the sample: Native Material for Backfill
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC
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: STA 205 + 15
Where the material sample would have been placed if not sampled:
