Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000061 DEA: 051Q4804 EFIS: 0523000036
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-R5.0/8.9
Work Description: RHMA OVERLAY, STRIPING AND MODIFY TRAFFIC STATIONS.
Location Description: SANTA CRUZ COUNTY FROM 0.9 MILE NORTH OF BUENA VISTA DRIVE UNDERCROSSING TO 0.2 MILE SOUTH OF RIO DEL MAR OVERCROSSING
Contractor Name: GRANITE ROCK COMPANY
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2024-10-03-30
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 10/03/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/03/2024
The quantity of what the sample constitutes: 10/03/24
A brief description of the sample: 1 jg of bwc
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TALLY OIL MADERA
