Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215075 DEA: 060Q9104 EFIS: 0614000005
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-19.2/19.8
Work Description: BRIDGE DECK AND OUTSIDE GIRDER REPLACEMENT.
Location Description: TULARE COUNTY NEAR TIPTON FROM 0.3 MILE SOUTH TO 0.3 MILE NORTH OF AVENUE 152 OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 2716 Granite Court, Fresno, CA 93706
Resident Engineer: Javier Huerta Structure Rep.: Peter Moua
DIME Sample ID: 2021-06-23-5
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California, LLC
Sample Organization Contact: (661) 630-7162
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 06/23/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/23/2021
The quantity of what the sample constitutes: 2515
A brief description of the sample: 1/2
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Con-Fab California LLC
Source Identification (SMARA, name of Pit or Job Site): SMARA 91 15 0041
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: silo
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:
Sublot number:
Aggregate Mix Number:
