Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215425 DEA: 06360244 EFIS: 0613000005
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-30.6/35.2
Work Description: Widen Freeway & Bridge Construction (Concrete Bridge)
Location Description:
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVE, SYLMAR, CA, 91342
Resident Engineer: Javier Huerta Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2024-10-15-55
TL Number from the TL Form: 00000
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Verification
Type of Material: Asphaltic Emulsion
Sample Taken Date: 10/15/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2024
The quantity of what the sample constitutes: 1 bottle
A brief description of the sample: ss1h
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Talley Oil - Madera
