Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000649 DEA: 061H3404 EFIS: 0625000042
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-23.49
Work Description: BRIDGE REPAIR FOR BR #46 0192
Location Description: Tulare County along NB SR 99 at Avenue 184 OC, Bridge #46 0192.
Contractor Name: Yarbs Grading and Paving, Inc.
Contractor Address: P.O.Box 87 Fowler, CA 93625
Resident Engineer: Amir Zamanian Structure Rep.: Luis Guzman
DIME Sample ID: 2024-10-17-45
TL Number from the TL Form: 027621
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Assurance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 10/17/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2024
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: SS1H 100%
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CENTENNINAL ASPHALT
