Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993868 DEA: 050C7324 EFIS: 0512000228
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-13.4/14.9
Work Description: CONSTRUCT PEDESTRIAN OVERCROSSING AND AUXILIARY LANE.
Location Description: SANTA CRUZ COUNTY IN AND NEAR CITY OF CAPITOLA FROM 0.2 MILE SOUTH OF 41ST AVENUE OVERCROSSING TO 0.2 MILE NORTH OF SOQUEL DRIVE OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 585 BEACH STREET, WATSONVILLE CA 95076
Resident Engineer: Gareth Gill Structure Rep.: Alejandro (Alex) Gomez
DIME Sample ID: 2025-05-27-1
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3675 - Santa Cruz Field Office
Sample Organization Contact: (925) 285-1217
Type of Sample: Acceptance
Type of Material: Methacrylate
Sample Taken Date: 05/27/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/27/2025
The quantity of what the sample constitutes: Multiple Lanes
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ennis-Flint and Swarco
