Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000514 DEA: 043Y5904 EFIS: 0423000264
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-680,680-1.47/24.26
Work Description: PLACE POLYESTER CONCRETE OVERLAY, GRIND BRIDGE DECK, AND PAVE SLOPE.
Location Description: CONTRA COSTA COUNTY AT VARIOUS LOCATIONS
Contractor Name: AMERICAN CIVIL CONSTRUCTORS WEST COAST, LLC. DBA ACC WEST COAST
Contractor Address: Unknown
Resident Engineer: Ramin Kalantari Structure Rep.: John Parecadan
DIME Sample ID: 2025-09-08-6
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3672 - Richmond
Sample Organization Contact: (510) 231-7108
Type of Sample: Acceptance
Type of Material: Methacrylate
Sample Taken Date: 09/08/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/08/2025
The quantity of what the sample constitutes: 3500 sqft
A brief description of the sample: METHACRYLATE
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier: 28-0315S
Structure name: Oakland boulevard overcrossing
The fabricator/manufacturer/facility name: ACC
