Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000436 DEA: 051P1804 EFIS: 0521000181
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-R5.0/8.2
Work Description: SHOULDERS WIDENING, ROADWAY EXCAVATION, HMA-A, AND RUMBLE STRIPS.
Location Description: SANTA CRUZ COUNTY FROM 0.9 MILE NORTH OF BUENA VISTA DRIVE UNDERCROSSING TO 0.2 MILE SOUTH OF ROB ROY JUNCTION OVERCROSSING
Contractor Name: GRANITE ROCK COMPANY
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-05-19-51
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 05/19/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/20/2025
The quantity of what the sample constitutes: 1 JG
A brief description of the sample: SS-1H 1jug emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Rock Redwood City
