Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000225 DEA: 023J3204 EFIS: 0222000034
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-3,36,299-Var
Work Description: BRIDGE POLYESTER CONCRETE OVERLAY & METHACRYLATE DECK SEAL.
Location Description: TRINITY COUNTY AT VARIOUS LOCATIONS
Contractor Name: Q&D CONSTRUCTION, LLC
Contractor Address: Unknown
Resident Engineer: Edward Worden Structure Rep.: Unknown
DIME Sample ID: 2024-09-26-60
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: 09/26/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/27/2024
The quantity of what the sample constitutes: 34 Totes
A brief description of the sample: 1 gallon can / PPC 1121 RESIN
From where was the sample collected: Source
Laboratory sample identification: 000134KBP
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
