Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215420 DEA: 060R2104 EFIS: 0614000058
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD-41-6.2/9.2
Work Description: FOR CONSTRUCTION ON STATE HIGHWAY IN MADERA COUNTY NEAR MADERA FROM 0.1 MILE NORTH OF AVENUE 15 TO 2.2 MILES NORTH OF FRIANT MADERA CANAL BRIDGE
Location Description: MADERA COUNTY NEAR MADERA FROM 0.1 MILE NORTH OF AVENUE 15 TO 2.2 MILES NORTH OF FRIANT MADERA CANAL BRIDGE
Contractor Name: CAL VALLEY CONSTRUCTION
Contractor Address: 5125 N. Gates Ave, Ste 102, Fresno, CA 93722
Resident Engineer: Ryan Wilson Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2023-07-10-15
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 417-5341
Type of Sample: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/10/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/11/2023
The quantity of what the sample constitutes: 0-750 Tons
A brief description of the sample: 3/4 HMA
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Madera Plant
