Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000269 DEA: 070W6604 EFIS: 0722000360
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-47,110,405,605-Var
Work Description: METHACRYLATE, POLYESTER OVERLAY AND JOINT SEALS.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: VELARDE CONCRETE CONSTRUCTION, INC
Contractor Address: Unknown
Resident Engineer: Joahnna Vergara Structure Rep.: Unknown
DIME Sample ID: 2024-09-30-5
TL Number from the TL Form:
Sample Submitted By Organization: Sika Corporation
Sample Organization Contact: (562) 941-0231
Type of Sample: Per Request
Type of Material: Rapid Set
Sample Taken Date: 09/30/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 4000 bags
A brief description of the sample: Rapid Setting Mortar
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sika - Riverside
