Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214627 DEA: 05344904 EFIS: 0500000505
QA Service Level: 1
DIST-CO-RTE-PM: 05-SBT-156-3/R8.2
Work Description: SAN BENITO ROUTE 156 IMPROVEMENT PROJECT SAN BENITO RTE 156 IMPROVEMENT PROJECT; INCLUDES NEW BRIDGE AND WIDENING OF EXISTING BRIDGE.
Location Description: SAN BENITO COUNTY IN AND NEAR SAN JUAN BAUTISTA FROM THE ALAMEDA TO 0.2 MILE EAST OF FOURTH STREET/BUSINESS ROUTE 156
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 223 Harrison Road 1B, Salinas, CA 93907
Resident Engineer: Frank (Farrukh) Sana Structure Rep.: Neil Weller
DIME Sample ID: 2025-05-08-62
TL Number from the TL Form: C0508251
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: No Test
Type of Material: Asphaltic Emulsion
Sample Taken Date: 05/08/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/16/2025
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: Emulsion SS-1h
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil
