Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000578 DEA: 112N1704 EFIS: 1122000283
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-805-15.72-28.3
Work Description: Bridge Preservation
Location Description: In San Diego at various locations from Landis Street Overcrossing to Sorrento Valley Boulevard Undercrossing
Contractor Name: Myers & Sons Construction
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Alex Balce Structure Rep.: Unknown
DIME Sample ID: 2024-11-04-4
TL Number from the TL Form:
Sample Submitted By Organization: Sika Corporation
Sample Organization Contact: (562) 941-0231
Type of Sample: Per Request
Type of Material: Rapid Set
Sample Taken Date: 11/04/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2 bags
A brief description of the sample: Quick Set mortar
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sika - Riverside
