Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213579 DEA: 051C2504 EFIS: 0512000107
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-68-1.6/L4.1
Work Description: SHOULDER WIDENING, RUMBLE STRIPS, STRIPING, AND UPGRADE GUARDRAIL.
Location Description: MONTEREY COUNTY IN AND NEAR MONTEREY AT VARIOUS LOCATIONS FROM 0.1 MILE EAST OF PIEDMONT AVENUE TO 0.1 MILE EAST OF SCENIC DRIVE OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 580 West Beach St, Watsonville, CA 95076
Resident Engineer: Bertha Roman Structure Rep.: Unknown
DIME Sample ID: 1900-04-25-2
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Sample Organization Contact: 8057463562
Type of Sample: Quality Assurance
Type of Material: Antistrip Additive
Sample Taken Date: 04/25/1900
Date that the sample was received by the laboratory/organization performing the testing: 04/25/2025
The quantity of what the sample constitutes: 750 tons or one day production
A brief description of the sample: PSU Sample
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: LAS Company
