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: 2024-06-12-92
TL Number from the TL Form: C000035
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 06/12/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/26/2024
The quantity of what the sample constitutes: 1 JAR
A brief description of the sample: SS-1H 80/20 HMA 3/4 TYPE A
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TALLY OIL INC
