Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214059 DEA: 042K7504 EFIS: 0417000019
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL-152-7.6/M10.2
Work Description: ROADWAY REHAB, CURB RAMPS, SIGNALS, AND STRIPING UPGRADES.
Location Description: SANTA CLARA COUNTY IN GILROY FROM 0.3 MILE WEST OF SANTA TERESA BOULEVARD TO ROUTE 101
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 585 West Beach Street, Watsonville, CA 95076
Resident Engineer: Gene Malonzo Structure Rep.: Unknown
DIME Sample ID: 2025-04-17-89
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/22/2025
The quantity of what the sample constitutes: 176.11
A brief description of the sample: 3/4" HMA-30%RAP
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: PEI CORES-GRANITE CON.
