Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000261 DEA: 010M6704 EFIS: 0123000054
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-R27.9/31.2
Work Description: MICRO-SURFACING, PAVEMENT DELINEATION, AND REPLACE AC SURFACING.
Location Description: DEL NORTE COUNTY NEAR CRESCENT CITY FROM WASHINGTON BOULEVARD OVERCROSSING TO ELK VALLEY CROSS ROAD
Contractor Name: DOOLITTLE CONSTRUCTION, LLC DBA DOOLITTLE ROAD CONSTRUCTION
Contractor Address: Unknown
Resident Engineer: Aaron Valley Structure Rep.: Unknown
DIME Sample ID: 2024-08-28-82
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 08/28/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/13/2024
The quantity of what the sample constitutes: 2 of 2 bottles
A brief description of the sample: Emulsion
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Emulsions Inc
