Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212800 DEA: 100G8304 EFIS: 1012000316
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-152,140,152-Var
Work Description: MERCED SEISMIC RESTORATION
Location Description: IN MERCED COUNTY ON STATE ROUTES, 59, 140 AND 152 AT VARIOUS BRIDGES.
Contractor Name: VIKING CONSTRUCTION COMPANY, INC.
Contractor Address: 11315 SUNRISE GOLD CIR. #A, RANCHO CORDOVA CA 95742
Resident Engineer: Jagga Dhami Structure Rep.: Natasha Collins
DIME Sample ID: 2024-07-16-37
TL Number from the TL Form:
Sample Submitted By Organization: CT D10 - Turlock Structures Construction Field Office
Sample Organization Contact: (209) 815-3666
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 07/16/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/17/2024
The quantity of what the sample constitutes: 16 CY
A brief description of the sample: Caltrans Class 1
From where was the sample collected: Job Site
Laboratory sample identification: 1-28-1, 1-28-2, 1-28-3, 1-hold-1, 1-hold-2, 1-hold-3
Structure unique identifier: 39-0034 L
Structure name: Eastside Bypass Channel Bridge No. 39-0034L
The fabricator/manufacturer/facility name: Central Valley Concrete
The concrete mix design number: 1922S-FC
The truck number from where the sample was collected: 295
The batch plant ticket number from where the sample was collected: 655030
Concrete batch plant: Central Valley Trucking
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Concrete sample from Truck
Where the material sample would have been placed if not sampled: Bridge No. 39-0034L Unsound Concrete Patch
From Lot No.:
Bag Lot No.:
