Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215183 DEA: 101C1704 EFIS: 1014000144
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-99-R12.7/17.8
Work Description: RECONSTRUCT ROADWAY WITH ROADWAY EXCAVATION, PLACE HMA AND CRCP.
Location Description: MERCED COUNTY IN MERCED FROM 0.2 MILE SOUTH OF CHILDS AVENUE OVERCROSSING TO 0.2 MILE SOUTH OF FRANKLIN ROAD OVERCROSSING.
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 4533 E. Citron Ave, Fresno, CA 93725
Resident Engineer: Wali Waziri Structure Rep.: George Samuel
DIME Sample ID: 2022-08-03-80
TL Number from the TL Form:
Sample Submitted By Organization: CT D10 - Turlock Structures Construction Field Office
Sample Organization Contact: (209) 815-3666
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 08/03/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/16/2022
The quantity of what the sample constitutes: 50 CY
A brief description of the sample: 4x8 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: MERCED NB G STREET BRIDGE
The fabricator/manufacturer/facility name: Buliders Concrete
The concrete mix design number: ND15518C
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 510144220
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: APPRAOCH SLAB
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-08-03-80-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: CT D10 - Turlock Structures Construction Field Office
Organization Address: 3240 North Millbrook Avenue,
Organization City: Fresno
Organization State: CA
Organization Zipcode: 93726
Organization Email: kelvin.low@dot.ca.gov
Organization Phone: (209) 815-3666
Data has not been verified.
