Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215183 DEA: 101C1704 EFIS: 1014000144
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-99-R12.7/17.8
Work Description: RECONSTRUCT ROADWAY WITH ROADWAY EXCAVATION, PLACE HMA AND CRCP.
Location Description: MERCED COUNTY IN MERCED FROM 0.2 MILE SOUTH OF CHILDS AVENUE OVERCROSSING TO 0.2 MILE SOUTH OF FRANKLIN ROAD OVERCROSSING.
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 4533 E. Citron Ave, Fresno, CA 93725
Resident Engineer: Wali Waziri Structure Rep.: George Samuel
DIME Sample ID: 2022-05-10-24
TL Number from the TL Form: MC220014
Sample Submitted By Organization: CT D10 - District 10 Materials Laboratory
Sample Organization Contact: (209) 948-7567
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/10/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/13/2022
The quantity of what the sample constitutes: 2 boxs
A brief description of the sample: 3/4 Hma-A
From where was the sample collected: Source
Laboratory sample identification: 22-h-28
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Santa Fe Winton
