Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995124 DEA: 060X3004 EFIS: 0618000051
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-33-69.4/71.5
Work Description: REPLACE ROADWAY PAVEMENT.
Location Description: FRESNO COUNTY IN AND NEAR FIREBAUGH FROM MORRIS KYLE DRIVE TO LYON AVENUE
Contractor Name: BAY CITIES PAVING & GRADING, INC.
Contractor Address: 1450 Civic Court, Building B. #400, Concord, CA 94524
Resident Engineer: Din Dadawalla Structure Rep.: Luis Guzman
DIME Sample ID: 2024-10-31-73
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 10/31/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/06/2024
The quantity of what the sample constitutes: 2 bottles of emulsion
A brief description of the sample: SS-1H EMULSION
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific northwest oil
