Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994443 DEA: 053307C4 EFIS: 0514000028
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-41,46-44.5/45.3,54.0/57.8
Work Description: Wye Segment - Route 41/46 Separation
Location Description:
Contractor Name: Atkinson Construction
Contractor Address: 18201 Von Karman - Suite 800, Irvine, CA 92612
Resident Engineer: Brian Harrington Structure Rep.: Dave Lewis
DIME Sample ID: 2025-03-19-52
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Whitley Gardens Field Laboratory
Sample Organization Contact: 805-540-9933
Type of Sample: Dispute Resolution
Type of Material: Hot Mix Asphalt
Sample Taken Date: 03/19/2025
Date that the sample was received by the laboratory/organization performing the testing: 03/21/2025
The quantity of what the sample constitutes: L230077A L2 SL 63C 250 tons
A brief description of the sample: 2x HMA boxes,63C core
From where was the sample collected: Job Site
Laboratory sample identification: 250319 L2 SL63
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sierra Pacific Materials - Avenal
