Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214627 DEA: 05344904 EFIS: 0500000505
QA Service Level: 1
DIST-CO-RTE-PM: 05-SBT-156-3/R8.2
Work Description: SAN BENITO ROUTE 156 IMPROVEMENT PROJECT SAN BENITO RTE 156 IMPROVEMENT PROJECT; INCLUDES NEW BRIDGE AND WIDENING OF EXISTING BRIDGE.
Location Description: SAN BENITO COUNTY IN AND NEAR SAN JUAN BAUTISTA FROM THE ALAMEDA TO 0.2 MILE EAST OF FOURTH STREET/BUSINESS ROUTE 156
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 223 Harrison Road 1B, Salinas, CA 93907
Resident Engineer: Frank (Farrukh) Sana Structure Rep.: Neil Weller
DIME Sample ID: 2024-10-14-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Quality Assurance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 10/14/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/14/2024
The quantity of what the sample constitutes: Skid Testing
A brief description of the sample: Portable Skid Testing
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Mainline NB 156
The fabricator/manufacturer/facility name: AT THE JOB SITE
Pavement Surface Type: CRCP (Continuously Reinforced Concrete Pavement)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE:
Direction of Travel: North
Post Mile:
Lanes to be Tested:
Station:
