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: 2024-08-05-24
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: 08/05/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/05/2024
The quantity of what the sample constitutes: 8.5 CY
A brief description of the sample: Calportland Type II/V Portland Cement
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 10-0G8304
Structure name: San Joaquin River (Santa Rita) Bridge 39-0028L
The fabricator/manufacturer/facility name: Central Valley Concrete
The concrete mix design number: 1922S-FC
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 655373
Concrete batch plant:
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 39-0028L Lane 1 left EOD widening
From Lot No.:
Bag Lot No.:
