Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000010 DEA: 061F8904 EFIS: 0623000107
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-63-4.0/5.5
Work Description: COLD PLANE AC PAVEMENT AND PLACE HMA.
Location Description: TULARE COUNTY IN AND NEAR VISALIA FROM AVENUE 264 TO VISALIA PARKWAY
Contractor Name: A. TEICHERT & SON INC DBA TEICHERT CONSTRUCTION
Contractor Address: 5771 S. Toyota Ave, Fresno, CA 93725
Resident Engineer: Tyler Street Structure Rep.: Unknown
DIME Sample ID: 2024-08-09-53
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Bakersfield Field Laboratory
Sample Organization Contact: 661-549-8281
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 08/09/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/09/2024
The quantity of what the sample constitutes: L1SL10
A brief description of the sample: HMA
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Jaxon Baker/Deer Creek
Source Identification (SMARA, name of Pit or Job Site): 91-54-0021
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: coldfeed
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number: 1
Sublot number: 10
Aggregate Mix Number:
