Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000521 DEA: 010P2604 EFIS: 0124000213
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101-59.9
Work Description: Bridge Deck Replacement
Location Description: Long Valley Creek Bridge
Contractor Name: Myers & Sons Construction
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Roozbeh Hadipour Structure Rep.: Behdad Saebi
DIME Sample ID: 2025-09-16-9
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Redwood Valley Field Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 09/16/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/16/2025
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: 23-10-0180
Structure name: Long Valley Creek
The fabricator/manufacturer/facility name: Myers & Sons
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: N/A
DIST-CO-RTE: 01-men-101
Direction of Travel: North
Post Mile: 59.90
Lanes to be Tested: Shoulder,Lane #1,Lane #2
Station:
