Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208942 DEA: 100Y2104 EFIS: 1013000104 COOP: 10415
QA Service Level: 1
DIST-CO-RTE-PM: 10-TUO-108-R4.3/R5.1
Work Description: MODIFY AND WIDEN STRUCTURE
Location Description: AT PEACEFUL OAK ROAD INTERCHANGE ,PART OF EAST SONORA BYPASS
Contractor Name: SIERRA MOUNTAIN CONSTRUCTION INC.
Contractor Address: 13919 Mono Way, Sonora, CA 95370
Resident Engineer: Corey Casey Structure Rep.: Ehab Wahed
DIME Sample ID: 2021-04-21-35
TL Number from the TL Form: C980848
Sample Submitted By Organization: CT D10 - District 10 Materials Laboratory
Sample Organization Contact: (209) 948-7567
Type of Sample: Preliminary
Type of Material: Soil
Sample Taken Date: 04/21/2021
Date that the sample was received by the laboratory/organization performing the testing: 04/23/2021
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Native Soil
From where was the sample collected: Job Site
Laboratory sample identification: 21-C-024
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sierra Mountain Const
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Roadway
Where the material sample would have been placed if not sampled:
