Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000382 DEA: 030N3504 EFIS: 0324000094
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-5-25/28
Work Description: Deck rehab with RSC. New Approach Slabs. New Barriers.
Location Description: Br 24-0207L/R. Br 24-0068L
Contractor Name: GRANITE CONSTRUCTION
Contractor Address: 4001 BRADSHAW ROAD, SACRAMENTO, CA 95827
Resident Engineer: Joni Tji Structure Rep.: Daniel Eggers
DIME Sample ID: 2024-09-18-31
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/18/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/19/2024
The quantity of what the sample constitutes: 2 Boxes
A brief description of the sample: 3/4" RHMA-G, PG 64-16, Type 2
From where was the sample collected: Source
Laboratory sample identification: 4308
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Bradshaw
