Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994574 DEA: 050C7334 EFIS: 0518000116
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-10.5/13.4
Work Description: CONSTRUCT OVERCROSSING AND AUXILIARY LANE/ Replace Capitola Ave OC + RWs and SWs
Location Description: SANTA CRUZ COUNTY IN AND NEAR CITY OF CAPITOLA FROM STATE PARK DRIVE OVERCROSSING TO 0.2 MILE NORTH OF BAY AVENUE UNDERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 580 West Beach Street, Watsonville, CA 95076
Resident Engineer: Fernando Dos Santos Structure Rep.: Daniel Dait
DIME Sample ID: 2024-12-18-38
TL Number from the TL Form: 279612
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: 12/18/2024
Date that the sample was received by the laboratory/organization performing the testing: 01/14/2025
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: EMULSION SS1H
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Juaquin Bakersfield
