Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993301 DEA: 060U2804 EFIS: 0615000293
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-245-1.4,4.2
Work Description: PRECAST PRESTRESSED CONCRETE BOX GIRDER AND SLAB, BRIDGE REMOVAL.
Location Description: TULARE COUNTY NEAR WOODLAKE AT YOKOHL CREEK BRIDGE AND AT KAWEAH RIVER BRIDGE
Contractor Name: MCM Construction
Contractor Address: PO Box 620, North Highlands, Ca 95660
Resident Engineer: Mike Garrett Structure Rep.: Benajamin Holton
DIME Sample ID: 2023-01-20-51
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Visalia Field Laboratory
Sample Organization Contact: (559) 341-4165
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 01/20/2023
Date that the sample was received by the laboratory/organization performing the testing: 01/20/2023
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: 1x4 concrete aggregates
From where was the sample collected: Supplier
Laboratory sample identification: 13
Structure unique identifier:
Structure name: Kaweah- Yokohl Bridges Wood Land
The fabricator/manufacturer/facility name: Viking Ready Mix Visalia
The concrete mix design number: ND22023
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 116206747
Concrete batch plant:
The fabricator/manufacturer designation for the sample: Viking Visalia Shirk Rd
A detailed description of where the material sample was collected: 1x4 Concrete Agg
Where the material sample would have been placed if not sampled: bridge deck
From Lot No.:
Bag Lot No.:
