Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995485 DEA: 031H1304 EFIS: 0316000059
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,SAC-12-0/0.7
Work Description: PLACE POLYESTER CONCRETE OVERLAY AND REPLACE BRIDGE RAILING.
Location Description: SOLANO AND SACRAMENTO COUNTIES IN AND NEAR RIO VISTA FROM VIRGINIA DRIVE TO ROUTE 160
Contractor Name: GOLDEN STATE BRIDGE, INC.
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Richard Kaufman Structure Rep.: Elaine Yip
DIME Sample ID: 2025-01-27-5
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - American River Bridge Field Office
Sample Organization Contact: (510) 501-7727
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 01/27/2025
Date that the sample was received by the laboratory/organization performing the testing: 01/27/2025
The quantity of what the sample constitutes: na
A brief description of the sample: skid test
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: na
Pavement Surface Type: RSC (Rapid Strength Concrete)
Type of Traffic Control Provided: Moving Lane Closure
DIST-CO-RTE:
Direction of Travel:
Post Mile:
Lanes to be Tested: Lane #1
Station:
