Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212737 DEA: 060S8304 EFIS: 0615000046
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-5-44.4-45.4
Work Description: TUMEY GULCH ABUTMENT REHAB BR# 42-0246L/R.
Location Description: IN FRESNO COUNTY AT TUMEY GULCH.
Contractor Name: Bruce Shumacher
Contractor Address: 2716 S Granite Ct, Fresno, CA 93706
Resident Engineer: Cary Cruz Structure Rep.: Ben Holton
DIME Sample ID: 2023-03-30-53
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 417-5341
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 03/30/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/31/2023
The quantity of what the sample constitutes: 300 CY
A brief description of the sample: structural concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 42-0246R
Structure name: NB Abut 2 Approach Slab
The fabricator/manufacturer/facility name: Unknown
The concrete mix design number: G67534SA
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 419830
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Discharge from concrete truck into wheelbarrow.
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
