Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215374 DEA: 060X2704 EFIS: 0618000048
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-5-37.2/48.8
Work Description: PAVEMENT REHABILITATION
Location Description: FROM 1.9 MILES NORTH OF THREE ROCKS ROAD UC TO 0.2 MILES SOUTH OF PANOCHE ROAD OC
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 2716 Granite Court, Fresno, CA 93706
Resident Engineer: Cary Cruz Structure Rep.: Unknown
DIME Sample ID: 2022-10-27-55
TL Number from the TL Form:
Sample Submitted By Organization: Structure Cast
Sample Organization Contact: (661) 301-2624
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 10/27/2022
Date that the sample was received by the laboratory/organization performing the testing: 10/28/2022
The quantity of what the sample constitutes: 9 CY
A brief description of the sample: Concrete Test Samples
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: StructureCast
The concrete mix design number: 06-0X2704
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 7389
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Discharge from truck into wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
