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: 2023-03-24-23
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: Aggregate
Sample Taken Date: 03/24/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/24/2023
The quantity of what the sample constitutes: 147 tons
A brief description of the sample: 3/4" HMA
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Tul 245 Kaweah- Yokohl Bridges Wood Land
The fabricator/manufacturer/facility name: MCM Construction
Source Identification (SMARA, name of Pit or Job Site): Unknown
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: Cored from in-place HMA on the roadway
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number: 1
Sublot number: 3
Aggregate Mix Number:
