Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000409 DEA: 051S1604 EFIS: 0524000176
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-1-60
Work Description: Rocky Creek Slip Out Permanent Restoration Project
Location Description:
Contractor Name: Gordon N Ball, Inc. (Fred Velasco/Stuart Yamamoto)
Contractor Address: 333 Camille Avenue, Alamo, CA 94507
Resident Engineer: Jorge Uberhuaga Structure Rep.: Daniel Dait
DIME Sample ID: 2025-02-20-5
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3675 - Monterey, Santa Cruz, San Benito
Sample Organization Contact: (805) 471-2109
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 02/20/2025
Date that the sample was received by the laboratory/organization performing the testing: 02/20/2025
The quantity of what the sample constitutes: Multiple Lanes
A brief description of the sample: Skid Testing
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 44-0302
Structure name: Rocky Creek Viaduct
The fabricator/manufacturer/facility name: Gordon Ball Construction
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE: 05-MON-001
Direction of Travel: South
Post Mile: 60.00
Lanes to be Tested: Lane #1
Station:
