Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995485 DEA: 031H1304 EFIS: 0316000059
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,SAC-12-0/0.7
Work Description: PLACE POLYESTER CONCRETE OVERLAY AND REPLACE BRIDGE RAILING.
Location Description: SOLANO AND SACRAMENTO COUNTIES IN AND NEAR RIO VISTA FROM VIRGINIA DRIVE TO ROUTE 160
Contractor Name: GOLDEN STATE BRIDGE, INC.
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Richard Kaufman Structure Rep.: Elaine Yip
DIME Sample ID: 2024-09-27-42
TL Number from the TL Form: Sacramento Caltrans lab
Sample Submitted By Organization: Kwik Bond Polymers
Sample Organization Contact: (760) 518-6064
Type of Sample: Quality Control
Type of Material: Polyester
Sample Taken Date: 09/27/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/30/2024
The quantity of what the sample constitutes: 2 tankers
A brief description of the sample: 1 gallon can / PPC 1121 RESIN
From where was the sample collected: Source
Laboratory sample identification: 000132KBP
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
