Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000571 DEA: 07354704 EFIS: 0718000355
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-710-22.0,22.2
Work Description: CLEAN AND PAINT BRIDGE.
Location Description: LOS ANGELES COUNTY IN COMMERCE AND VERNON AT HOBART YARD OVERHEAD AND AT ATLANTIC BOULEVARD AND BANDINI BOULEVARD ON-RAMP
Contractor Name: CERTIFIED COATINGS COMPANY
Contractor Address: Unknown
Resident Engineer: Martin Oregel Structure Rep.: Daiel Alvira
DIME Sample ID: 2025-05-20-61
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Chemistry Laboratory
Sample Organization Contact: (916) 227-7912
Type of Sample: Quality Assurance
Type of Material: Paint
Sample Taken Date: 05/20/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/21/2025
The quantity of what the sample constitutes: 1/2 pt
A brief description of the sample: PWB-174A
From where was the sample collected: Manufacturer
Laboratory sample identification: C250677
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Stiles Paint
Batch No.: 782525
Color: 26622 Light Gray
Batch size: 400 gals
Date of Manufacturing: 2025-05-20
Paint Specification: PWB 174
Paint Specification Version: A
